a web based integrated health care management system

8/8/2019 A Web Based Integrated Health Care Management System

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A Web-Based Integrated Health Care Management System

MOHAMMED ABDULLAH ALI AL-KHAWLANI

FACULTY OF COMPUTER SCIENCE

AND INFORMATION TECHNOLOGY

UNIVERSITY MALAYA

KUALA LUMPUR

APRIL 2009


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A Web-Based Integrated Health Care Management System

MOHAMMED ABDULLAH ALI AL-KHAWLANI

DISSERTATION SUBMITTED IN FULFILLMENT

OF REQUIRMENT FOR THE DEGREE OFMASTER OF INFORMATION TECHNOLOGY

FACULTY OF COMPUTER SCIENCE

AND INFORMATION TECHNOLOGY

UNIVERSITY MALAYA

KUALA LUMPUR

APRIL 2009

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GRADUATE SCHOOL

UNIVERSITY MALAYA

Permission to use

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Abstract

Health Care Management Systems has a set of important patient information stored in

electronic formats that provides health care staff the flexibility and accessibility to

easily interact with the patient's information, which helps to improve the quality of the

health care service. Managing the patient's information has been developed and

improved through different manners such as web-based systems, computer applications

analyzed from current problems within the system, system requirements, database

servers and user requirements.

Many problems appear as blockage for managing the health care information system.

These problems emerge in the patient's medications, consultations, and appointments,

confirming appointments, payments and doctor schedules. This research analyzes the

previous studies and the available problems of the current system in two health care

providers namely the University Hospital (UH) and Hospital of University Kebangsaan

Malaysia (HUKM). This system is a web-based integrated health care management

system, which contains the main modules such as patient module, doctor schedule

module and appointment module. This manages the patient information history

(personal information, medical information, treatment information, payment

information, and appointment information) with the easiest method and sturdy security.

In addition, this integrated web-based gives the patient the opportunity to use the system

online and confirm their own appointments by themselves, a matter that saves time and

effort of both the patient and the nurse. Moreover, by this integrated web-based, patient

will be able to check the status of their appointment and doctor availability online.

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Acknowledgment

First of all, I would like to express my appreciation to Allah, the Most Merciful whom

granted me the ability and willing to start and complete this dissertation. I pray to his

greatness to inspire and to enable me to continue the work for benefits of my religion,

Islam and country.

I would also like to express my gratitude and a million thanks and appreciation to my

supervisor, Dr. Norizan Mohd Yasin, the Head of Department information science,

Faculty of computer science and information technology at the University Malaya for

her efforts and excellent guidance and advice to finish this dissertation successfully.

I would also like to express a million thank and appreciation to my family for the solid

home support. They graciously understood my tight time schedule during doing this

dissertation. And my greatest thanks to all my friends for their kind assistance and

cooperation.

Thanks for every never-endings support and kindness. May Allah bless us, Insha Allah.

Only God knows everything!

Thank you.

Mohammed Abdullah Ali Al-Khawlani

Information Science Department,

Faculty of Computer Science and Information Technology,

University Malaya

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Table of Contents

Permission to use iii

Abstract iv

Acknowledgment v

Table of Contents vi

List of Tables viii

List of Figures viii

Appendixes x

Chapter 1

Introduction

1.1 Background 1

1.2 Research Focus 3

1.3 Problem Statement 4

1.4 Research Objectives 5

1.5 Research Significant 6

1.6 Research Scope 7

1.7 Organization of Thesis 8

1.8 Conclusion 8

1.9 Summary 9

Chapter 2

Literature Review

2.1 Introduction 10

2.2 Health Care Information system 112.3 Definitions of information system and health care information system 122.4 Health Care Management system 142.5 Patient Appointment system 202.6 Managing Patient Appointment system 212.7 Critical analysis for previous research 392.8 Conclusion 452.9 Summary 46

Chapter 3Research Methodology

3.1 Introduction 473.2 Research Strategy 473.3 Data Collection 49

3.3.1 Data Collection Techniques 493.3.2 Data Collection Tools 50

3.4 Research Sample and Respondent 503.5 Plan of Data Collection 513.6 Framework for Data Analysis 523.7 System Development 533.8 Conclusion 553.9 Summary 55


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Chapter 4

Data Collection, Analysis and Findings

4.1 Introduction 56

4.2 Case study 57

4.2.1 Case 1 (UH) University Hospital 57

4.2.2 Case 2 (HUKM) Hospital of University Kebangsaan Malaysia 594.3 Data Capture 61

4.4 Data Analysis 63

4.4.1 University Hospital (UH) 66

4.4.2 Hospital of University Kebangsaan Malaysia (HUKM) 70

4.5 Finding 74

4.6 System Testing 78

4.7 Feed back 83

4.8 Conclusion 84

4.9 Summary 85

Chapter 5

System Design

5.1 Introduction 865.2 System Structure 86

5.2.1 System Concept 865.2.2 System modules 875.2.3 System Environment 88

5.3 Functional Requirement 895.4 Non Functional Requirement 89

5.4.1 Integrity 895.4.2 Flexibility 905.4.3 Security 905.4.4 Maintainability 90

5.5 System Interface 915.5.1 User Interface 915.5.2 Hardware Interface 1345.5.3 Communications Interfaces 134

5.6 System Tables 135

5.7 System Code 137

5.8 Conclusion 1505.9 Summary 150

Chapter 6

Discussion and Conclusion

6.1 Introductions 151

6.2 Contribution to Knowledge 152

6.3 The Research Outcome 153

6.4 System strength 153

6.6 System Limitation 155

6.5 Recommendation and Future Work 155

6.7 Research Conclusion 156

References 157


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List of Tables

Table 2.1 Appointment Type 32

Table 2.2 Basic Patient Flow Logic 33

Table 2.3 Critical analyses, system features and types for previous studies based

on the literature review42

Table 2.4 Limitation and strength of the health care system based on the previousstudy in the literature review

44

Table 3.1 Research Respondent 50

Table 4.1 The analysis of data collected 64

Table 4.2 UH Nurse, use system for creating patient profile and setting

appointment80

Table 4.3 UH Patients use system to confirm the appointment 80

Table 4.4 HUKM nurse use system for creating patient profile and setting

appointment81

Table 4.5 HUKM Patients use system to confirm the appointment 82

List of Figures

Figure 2.1 Patient accesses their own medical records 16

Figure 2.2 Integrated web page Patient Gateway portal 18

Figure 2.3 The Integrated Tbase system 19

Figure 2.4 Single point of access to the health care gateway 20

Figure 2.5 Patient appointments Flow Chart 26

Figure 2.6 Information about physicians 27

Figure 2.7 Appointment time table 27

Figure 2.8 Patient Flow diagram 29

Figure 2.9 Patient Flow diagram 31

Figure 2.10 Patient processes in the clinic 35

Figure 2.11 Patient information for registration 36

Figure 2.12 Patient appointments (electronic booking) 37

Figure 2.13 Patient appointments process 38

Figure 2.14 Conceptual framework for health care system based on the literature

review

43

Figure 2.15 Conceptual framework for the appointment system based on the

literature review

43

Figure 3.1 Framework of data analysis 52

Figure 3.2 Waterfall method 53Figure 4.1 The current system construction use in UH and HUKM 65

Figure 4.2 Network design topology for hospital UH and HUKM 66

Figure 4.3 Patient flow steps (Chart) in UH 69

Figure 4.4 Patient flow steps (Chart) in HUKM 73

Figure 4.5 The new integrated module 75

Figure 4.6 Finding Module form the Current System Used for Managing the

Patient Appointment

76

Figure 4.7 The new module for managing the patient appointment 77

Figure 5.1 The structure chart of the new application 87

Figure 5.2 System users as group 89

Figure 5.3 Login interface 91Figure 5.4 Today Queue 92

Figure 5.4.1 Search Patients 93


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Figure 5.4.2 Create new Patients 94

Figure 6.4.3 View appointments 95

Figure 5.4.3. (a) Appointment list 96

Figure a1 Edit Appointments 96

Figure 5.4.4. (a) View Documents 96

Figure a1 Downloading document 98

Figure 5.4.4.b Upload file 98Figure b1 Locate upload file 99

Figure 5.4.4. (c) Managing files 99

Figure c1 Editing /Deleting file 100

Figure 5.4.5 View My Tasks 101

Figure 5.4.5. (a) Editing/ Deleting Task 102

Figure 5.4.5. (b) Creating a new Task 102

Figure 5.4.6 Doctor Schedule 103

Figure 5.4.6. (a) Doctor Schedule History 104

Figure 5.4.6. (b) Editing Doctor Status 104

Figure 5.4.6. (c) Creating New Status 105

Figure 5.4.6. (d) Doctor Schedule and status history 105Figure 5.4.7. (a) View Report (Appointment) 106

Figure 5.4.7. (b) Patients Gender Report 107

Figure 5.4.7. (c) Patients Race Report 107

Figure 5.4.7. (d) Payment Report 108

Figure 5.4.7. (e) Payment method Report 108

Figure 5.4.7. (f) Doctor Consultation Report 109

Figure 5.4.7. (g) Client Report 109

Figure 5.4.7. (h) Document Report 110

Figure 5.4.7. (i) The Patient Complaint Report 110

Figure 5.4.7. (j) The Patient Treatment Report 111

Figure 5.4.7. (k) The Diagnosis Category Report 111

Figure 5.4.7. (l) The Total Product Used Report 112

Figure 5.4.8 Patients list 113

Figure 5.4.8. (a) Patient details 113

Figure 5.4.8. (b) Full Patient Details 114

Figure 5.4.8. (c) Patient previous illness details 115

Figure 5.4.8. (d) Patient consultation history 115

Figure d1 The Patient Consolation Details 116

Figure d2 Patient Consolation Diagnosis 116

Figure d3 Patient Medication 117

Figure d4 Patient Payment page 117Figure 5.4.9 Patient Appointment History 118

Figure 5.4.9. (a) Create/ Edit appointment 119

Figure 5.4.10 Patient allergies 119

Figure 5.4.11 Admin home page 120

Figure 5.4.11. (a) User Management 121

Figure 6.4.11. (b) Edit/ Create user 121

Figure 5.4.12 Group Management 122

Figure 6.4.12. (a) Edit/ Create group 122

Figure 5.4.13 System Management 123

Figure 5.4.13. (a) System Profile 123

Figure 5.4.13.b System Code Control 124Figure b1 Edit/ Create System Code 124

Figure 5.4.14 Account Management 125


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Figure 5.4.14. (a) Edit/ Create account management 126

Figure 5.4.15 Client management 126

Figure 5.4.15. (a) Edit/ Create Client 127

Figure 5.4.16 Vendor management 128

Figure 6.4.16. (a) Edit/ Create vendor 129

Figure 5.4.17 Product Management 130

Figure 5.4.17.(a) Create / Edit product 131Figure 5.4.18 Patient Home Page 132

Figure 5.4.18. (a) Patient View the Appointment 133

Figure 5.4.18. (b) Patient Confirm the Appointment 133

Figure 5.4.18. (c) Patient cancels the Appointment 134

Appendixes

Appendix A primary collected data

Appendix a-1 Doctor HUKM 162

Appendix a-2 Nurse1 HUKM 166

Appendix a-3 Nurse2 HUKM 170

Appendix a-4 Patient 1 HUKM 174

Appendix a-5 Patient 2 HUKM 176

Appendix a-6 Nurse1 UH 178

Appendix a-7 Patient 1 UH 181



Appendix a-10 Doctor HUKM 187

Appendix B feedbackAppendix b-1 Doctor Feedback HUKM 193

Appendix b-2 Nurse 1 Feedback HUKM 195

Appendix b-3 Nurse 2 Feedback HUKM 197

Appendix b-4 Patient 1 Feedback HUKM 199





Appendix b-9 Nurse1 Feedback UH 204

Appendix b-10 Nurse 2 Feedback UH 206

Appendix b-11 Patient 1 Feedback UH 207





AppendixC system use case 213

Appendix D System Table 235

Appendix E System Chart Code 248


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CHAPTER 1

Introduction

1.1 BackgroundInformation systems is collection of hardware, software, data, people and

procedures that are designed to provide the right information the user needs to do their

task more effectively, to the right person and at the right time (Davis and Yen, 1998).

Information system is important for any business because the business needs to

have accurate information and need to have the technology as a tool for solving

problems and at the same time increasing the productivity and the quality of doing

business. Businesses today use information system and use the available technologies

because they understand the importance of maintaining and updating data electronically

(Davis and Yen, 1998).

Using information system for managing information in the health care such as

patient record, patient appointment system, patients scheduling appointment, doctor

schedule and medicine prescription is not only to save time or reduce cost, but also a

way to support and improve the health care information to be more accessible and

flexible (modifying, saving, deleting, updating etc) for system users and storing data

efficiently. In addition, it improves the quality of data control (Liu and Zhu, 2007).

On the other hand, information system works to interact with the system

databases, financial module, scheduling module and the entire system modules.

Therefore, to get the best implementation, the health care system should be able to

interact with several medical health care staff (physicians, nurses, medical device users,

financial and the administrators),


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which is the conducted way to get a good insight how health care system working and

will be more effectively and efficiently for managing the information (Song et al.,

2007).

Health care information system is looking at patients, in order to represent their

health information history and provide the flexibility and accessibility for patient

information to be more reachable by the authorized person (Rogers et al., 2006).

On the other hand, health care information system have user interface, that

provides to the system user the ability to interact with the patient; Once the patient

arrive at the medical center they must register their information and health history in the

health care center system. The system automatically will update the patient information;

then the patient will be under queue to have an appointment for medical check up by the

physician. The physician will specify whether the patient case is an emergency case or

not. If the case is an emergency, the physician will retrieve the relevant patient

information from the system database. Nevertheless, in the general case, the system will

request the examination queue for the patient. Finally, after the patient complete the

medical check the system will place the prescription order to the pharmacy unit and

update the information to the patient record (Tang et al., 2001).

The challenge here is how the information system can represent and manage the

entire information in the health care such as patient information, patient consultation

history, patient appointment, doctor's schedule, payment, products and medicines, and

document. In addition, how an integrated system can provide the accessibility to the

right and accurate information for any patient in the health care center. Moreover, how

the system can provide the accessibility for patients to allow them confirm their own

appointment by themselves.


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1.2 Research Focus

The focus of this research is to study the following areas towards the

development of an integrated health care management system:

a. Patient information history, which include all the patient information such asconsultation history, medication history, treatments history, appointments.

b. Doctors schedule information, which include the doctor schedule status suchas (available, on leave, oversea, operation day etc)

c. Products, such as medicine information, which contains the products pricesand the supplier for the product.

d. Third party interest such as insurance companies and companies' information.A patient can be a business client of an insurance company.

e. Managing the patient appointment and giving the opportunity to the patient toconfirm their own appointment by themselves online.

The expected outcomes for focusing on those points in this research are:

a. Providing an integrated health care system to the health care.b. Improving the quality of health care services.c. Keep tracking for all the patient information and patient consultation history.d. Managing the doctor schedule.e. Managing the patient appointment.f.

Giving the patient the opportunity to confirm their appointment by

themselves online, which help to:

Reduce the working load of nurse. Reduce unnecessary waiting time for patients and staffs. Encouraging continuity of medical care.


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1.3 Problem Statement

The current health care providers are using different ways and systems for

managing information. Some health care providers are using only one system for

managing the health information but it is not comprehensive for managing all the

information, for instance the system can support only the patient information but cannot

support the patient appointment or cannot support the doctor schedule.

Therefore Mazzi et al. (2006) reported results of study about current system use

in the health care, which proved that there is a lack of software that fulfils the patients

need for medical information and the doctors need to monitor patients.

Conversely, there are a health cares are using more than one health management

system such as (patient information, doctor schedule, products and medicine suppliers,

financial etc.) for managing the health information. Those system are dedicated to only

one activity of the healthcare and this functionality is not integrated with other systems

(Mazzi et al., 2006).

Furthermore, about the patient appointment, the patient can book an appointment

through a different way such as (telephone, email, website etc); otherwise the patient

needs to go to the health center personally to make an appointment.

Traditionally, the doctors time is more important than patient time. So an

appointment system designed to minimize the doctor idle time only and considered that

the patient can wait for more than one hour to be attended by a physician in a health

care center, which make patients feel they are being disregarded and treated unfairly

(Dexter, 1999).


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On the other hand, the old appointment system designed to minimize the doctor

idle time but current designing of an appointment system is based on decisive factors

with respect to both the patient and doctor (Wijewickrama and Takakuwa, 2005).

Therefore, here is the necessity of developing an integrated health care system

that can manage the entire health care information and provide a very sturdy interacting

communication between the system component and system users.

1.4 Research ObjectivesThe objective of this research is to:

a) Identify and analyze the current system used for managing patientinformation and health care information.

b) Design and Develop an integrated system for managing the patientinformation and the health care information.

c) Develop the confirmation appointment system to allow patient to confirmtheir appointment by themselves online.

d) To enhance the protection of patient health information history and providesthe flexibility and accessibility of the information to be more reachable by

authorized personnel.

e) Observe and control the huge information of health care (diseases, finance,medication, treatment, out patients etc) to enhance the ability of evaluating

the work in the health care, which provides the necessary information for

future planning.

f) Provide very secure communication between patients and physicians. Inaddition, incorporates services such as prescription renewal and

appointment.


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1.5 Research Significance

An integrated health care management system provides an electronic document

instead of using the traditional method (paper document), which is not easy to retrieve

patient information and can not accesses remotely.

Therefore, Zeng and Cimino, (2000) mentioned that because of the huge of

patients information in the health care, it is not practical to keep going using the paper

documents for tracking and managing the patient information , but information system

in health care, systematicallysupports extensive manage for the of patients information

in the health care and keep tracking for all medication details

Moreover, Wilcox et al., (2005) refer that the traditional method (paper

documentation) it is limited aptitude for saving patient information, retrieving patient

information etc and cannot access it remotely. From this issue, the importance of health

care information system that can provide the flexibility and supports remote access to

patient health information.

On the other hand, regarding to Brown et al. (2008) a health care management

system provides an extensive patient record, which helps to make proper diagnoses and

prescribe proper treatments and provides track crucial medical information, insurance

data, consultation history, medications and special conditions, which means improve the

quality of health care and enhance the health care performance by allowing the

physician to diagnose diseases faster and more safely since historical information will

be collected from numerous sources to present an obvious picture of a patients health at

the point of care. Furthermore it provides consolidated reports for all patient records,

and historical data.


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1.6 Research Scope

i. This research is for analyzing and developing a web based integrated system tomanage the entire information in the health care such as:-

- Patient information: personal patient information, patient consultationshistory, patient treatments and diagnosis, patient medications history,

patient appointments, confirming the appointment online, patient

documents, and patient payments.

- Doctors schedule information.- Products and medicine information.- Health care client information such as insurance companies.

ii. This system can be used online through World Wide Web by the users,however the security need to be focused.

iii. The doctor and the nurse can observe the patient health based on theconsultation history for each appointment.

iv. This system manages the patient appointment and allows the patient to usethe system online and confirm their own appointment by themselves.

However, the patient cannot change the appointment time or date, they have

to see the nurse to do that and the patients are not allowed to booking the

appointment by themselves.

v.

Before the patient can use the system, the patient must register through the

nurse to create the user account.


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1.7 Organization of Thesis

This research contains seven chapters to cover the entire academic research

requirement. Chapter one covers introduction and background about information system

and how the Information system supports health care and highlights the system

limitation and system significant, in addition to research objective and problem

statement.

Chapter two highlights the literature review which is related to what the earlier

researches have done in the aspects of health care information system. Chapter three

highlights the research methodology. This chapter covers the research methods that the

researcher uses to collect data to determine the user requirements needed to develop the

system. Chapter four highlights the case study and data collection. Chapter five covers

the data analysis, finding, developing, implementation and testing. Chapter six covers

all the concepts about the system designing and finally chapter seven highlights the

research results and conclusion.

1.8 Conclusion

This chapter has introduced that the information system use in the health care to

manage the health care information such as patient information, medical information,

appointments etc. and presents the research focus, which is studying many areas (patient

information history, medication history, doctors schedule information, products,

insurance companies, managing patient appointment) toward developing an integrated

health care management system, because the current health cares are using non

integrated system for managing their information. So, this research aims to develop an

integrated health care management system.


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1.9 Summary

Introduction chapter is the initial chapter that represents the research headline

and research objectives. This chapter starts by presenting health care information system

backgrounds, definitions and importance of information system in the health care. Next

the research focuses on the research area study and the expected outcomes from this

research. Moreover, the scope of this research is about managing the patient information

in the health care center.

On the other hand, the problem statement of this research is to analyze how the

current health care centers use the information system for managing patient information

and patient appointments. The objective is to develop an integrated health care

management system. Hence, the significance of this research comes from the

importance of using health care electronic record to provide a complete patient health

records to make proper diagnoses, prescription, and treatments. It is also to track down

all patient information. The next chapter is the literature review of previous studies.


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CHAPTER 2

Literature Review

2.1 Introduction

Information system is an enabler for operation process in an organization.

It plays a major role for interactive process service in the organization system by

updating, saving, deleting, retrieving, storing, and sharing data. In addition an operating

and robust information system provides the right information to the right person at the

right time with the lowest cost (Mehdi et al., 2004).

Therefore, in the business world today, most organizations would prefer to use

information system to manage their database, which include among others, the name of

business employee and work schedule. As data and information are increasing and

becoming more complex with time, computerize data are unavoidable not only to

improve the performance of practical works but also safeguard the database from bad

intentions such as hacking and doodling.

Information system uses a client-server environment to provide flexibility for

interactive adding, deleting, updating, etc of data among the clients. In addition to

managing data, it also distributes data based on client-server environment, thus

increasing its efficiency (Mehdi et al., 2004).

The challenge here is how an information system manages the health care

database to save time and reduce cost and improve the quality of services. A health care

system generates a large amount of patient data, archived and can be manipulated by a

computer based information system. For instance, a computer-based medical record

improves the accessibility of patient information and provides useful data for several

studies in patient health information.


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This chapter highlights earlier researches on health care management system,

which contains several aspects of managing the health care and the health care

information systems. The chapter starts with the introduction on information system and

how it supports patient's health care. Then, it highlights the health care management

model and managing the appointments in the health care information system, touching

on previous studies on managing the appointment system in the health care center.

Finally, the advantages and disadvantages of the current system used in health care

center are discussed.

2.2 Health Care Information systemUsing information system for managing patient information such as electronic

patient record, patient appointment system, and patients scheduling appointment system

not only saves time but also reduces cost. It is a means to support and improve patient

information availability to be more accessible and flexible (modifying, saving, deleting,

updating. etc) for users (health care center staff); and to store patient data efficiency.

Moreover it improves the quality of data control (Liu and Zhu, 2007).

On the other hand, information system works as guidelines, using system

prototype, patient monitoring and documentation tools to integrate the health care

information database, financial system, scheduling and the entire user requirements -

patient, nurse, doctor, etc. Therefore to get better performance and implementation, the

system developers should interact with several medical health care staff physicians,

nurses, medical device users, finance personnel and the administrators, to have an in-

depth knowledge of how the health care center works (Song et al., 2007).

Furthermore, any process or sub-process in the health care system of an existing

information system provides a service to the patient. This service is produced

within a particular process according to defined requirements, rules, and constraints.


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Consequently, a health care system needs to manage patient services, while it is

working with users to improve the system performance and the quality of health care

(Snyder et al., 2005).

Nevertheless, a health care information system is still not utilized in many health

care centers because of the lack of economic incentive and cost-benefit justification, let

alone developing the ability to share information with different systems and the ability

to change from the traditional environment based paper documentation to the new

digital environment (Liu and Zhu, 2007).

2.3 Definitions of information system and health care information systemAn information system is an arrangement of information technologies used for

capturing, storing, and distributing data to meet an organization needs. These include

computer hardware, operating system and application software as well as

telecommunication and networking technologies. Profit making business enterprises,

non-profit making charity bodies, social organizations and government agencies all rely

on information systems to be effective (Wikipedia.org, 2008).

Hence, health care information system is a computer application for patient

health center to represent patient information in a user friendly interface to allow users

to review and interact (adding, saving, modifying, deleting, etc) with patient health

information, such as diagnosis, medicine orders and other services. Moreover,

application health information system works as data repository for patient health

information such as patient registration, systems administrator and financial

management (Giffin et al., 2006).

In addition, a health care information system has a set of important patient

information stored in electronic format that provides health staff, the flexibility and

accessibility to patient's information, stored in the system server.


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On the other hand, an Electronic Patient Record (EPR) is defined as the process

to convert the traditional documentation medical paper based records into electronic

computer based information system medical records. These include all patient medical

records such as written text, codes, images, audios, and video notes and any other

information related to the patient (Liu and Zhu, 2007).

In the same manner Laserfiche (2007) developed application software to

improve the health care services in the health care called EMR/HER. Initially EMR

/HER are working to reduce using paper inside the health care through generating an

electronic health record or electronic medical record for each patient and improving the

electronic document management (EDM). Moreover, this system can work as two

categories.

1- Stand alone: typically focus for developing comprehensive functions that can be

used in a side-by-side manner or integrated with other applications. This category

helpful for health care that required a document management and caring about the

digital record.

2- Add-on modules to primary applications: Realizing the need and importance

functions, that makes it easily to linking to a specific record which help the health

care that care about integrating a module with the primary application.

The advantages of this application are the ability to be integrated with other

application based on the user requirements such as the following:-

i. Side-by-side: Most people are familiar to working with multiple applications like

Outlook, word and excel. Electronic document management system provides very

easy way to switch to for retrieval the electronic records.

ii. Data Look-Up: EDM provides solution to populate template automatically, and the

source of the populated data for instance a data stored in another application such as

a practice management or an EMR system.


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iii. Data Push to Other Applications: which mean the data that is manually or

automatically captured in template fields can be exported to other applications.

iv. Image-Enablement: The most common integration of stand-alone EDM with third-

party applications involves searching the document repository from within the other

application by activating an option in EMD to activate the function.

2.4 Health Care Management systemIt is very important to keep extensive information of patients, but it is not easy to

retrieve them from traditional patient records (papers) because the amount of available

data about patients is huge. So, initially the importance of information system in health

care has originated from this issue, which means systematically replacing the papers

documentation in health care to electronic media record (Zeng and Cimino, 2000).

Moreover, a health care information system protects patient health information

history and provides the flexibility and accessibility of the information to be more

reachable by authorized personnel (Rogers et al., 2006).

Therefore, paper documentation is not practical as it has limited aptitude (saving

patient information, retrieving patient information, etc) to support patient health care

and cannot be accessed remotely. Health care information system addresses these

limitations by providing the flexibility (saving, updating, modifying, deleting, etc) to

patient information. In addition, it supports remote access to patient health information

(Wilcox et al., 2005).

According to Brown et al. (2008) the benefit for using the health care

information system is to provide a complete patient health records to make proper

diagnoses and prescribe proper treatments and provides track crucial medical

information, insurance data, consultation history, medications, and special conditions.


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In addition, using the information system to improve the quality of health care to

improve the health care performance in several ways such as allowing the physician to

diagnose diseases faster and more safely since historical information will be collected

from numerous sources to present an obvious picture of a patients health at the point of

care.

According to Ibrahim (2002) using the Health Management Information System

(HMIS) it is an effective way for planning, developing, co-ordination and evaluation the

work in the health care because it is linked the Health Information system to the

management, which provides the necessary information for future planning. Moreover,

the health care integrated system its not only for managing patient information but it

also is used for managing the entire health care information, which is the best way to

observe and control the huge information of health care (diseases, finance, medication,

treatment, out patients, etc).

According to Stolyar et al. (2006) the health information system supports patient

health care and gives patients the opportunity to access their own medical health

information. Patients can access health information, modify and control information in

their records. In addition, the system also allows patients to keep their medical health

record even if they change the doctor.

Ciminoa et al. (2000) developed a health care information system with a

common gateway interface that presents a set of applications to patients, organized into:

i. Data Entry which contains entering information into the patient record.

ii. Data Review which contains reading and retrieving information stored system

database.

iii. Education which contains information resources on various topics.

iv. Advice which contains application of patient data to be online guidelines.


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The system developed by Ciminoa et al. (2000) gives patients the opportunity to

access their own medical records and to observe the results for a patient view (Figure

2.1). In addition, the health care data are presented in the same manner that is used to

present to the health care staff.

Figure 2.1 Patient accesses their own medical records

(adapted from Ciminoa et al., 2000)

Chua (2005) developed a Tele Primary Care implemented as distributed

application has a repository of medical records for patients. The health care maintains

the patients Electronic Medical Record (EMR), which are local to each clinic in the

health care and contains patients medical history, surgeries, immunizations, risk

factors, and health and activity status, providing a historical database. In addition, this

system maintains the central repository by having the member clinics update the

repository. Other advantages for this system in the following:

i. Capability to capture online EMR for all patients at primary care area.

ii. Consolidated reports for all patient records, and historical data.

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Patients often do not know if their symptoms are serious enough to see a doctor.

Agents can help to identify those patients who really need medical attention

from those that only need information

Better treatment completion

Wald et al. (2004) developed a web page Patient Gateway portal called

Longitudinal Medical Record (LMR). This system is an electronic medical record

system used by physicians and other clinical staff in the outpatient setting to automating

the documentation of medical care, including patient problems, procedures,

medications, allergies, health maintenance topics, and encounter notes. In addition LMR

is used to write prescriptions and to communicate with other providers.

The main concept for LMR system (see Figure 2.2) is web-based health care

management system portal to provide very secure communication between patients and

physicians, in addition incorporates services such as prescription renewal and

appointment.

Figure 2.2 Integrated Web Page Patient Gateway Portal

(adapted from Wald et al. 2004).

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Lindemann-v et al. (2002) developed a TBase2 health care system. This system

is designed to store relevant data for each patient and allow access to that data by all

persons who are authorized to do so in the health care. In addition, there exists an

intranet within the health care that allows connecting almost every computer to the

health care system (TBase2) (Figure 2.3). TBase2 is designed to comprise the whole

medical information about a patient, e.g. medical free-text, numerical data, standard

definitions and medical images. Moreover, it is presented at web-based electronic

patient record of transplantation patients running in the daily routine of large health care

distributed over a wide area.

Figure 2.3 The Integrated Tbase system

(adapted from Lindemann-v et al., 2002)

Lim et al. (2006) developed a portal web-based healthcare system that integrates

components such as patient management, patient accounting, appointment, house call

and communications into one complete package solution. These components are

developed using portal technology. A healthcare web portal serves as the integrated

getaway in a healthcare centre website and provides to the users a single point of access

(Figure 2.4) for the healthcare services delivery. This portal technology supports single

point of access and also different accessing levels to prevent patients records being

accessed by un-authorized personnel while maintaining one simple gateway for all

levels users.

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Figure 2.4 Single point of access to the health care gateway

(adapted from Lim et al., 2006)

A health care information system has an interface that facilitates the user to

interact with the system. So, once the patients arrive at the clinic, they must register

their personal information and health history in the health care center. The system

automatically updates the patient information. Then, the patient will be under queue to

make an appointment for medical check-up by a physician. Next, the physician will

specify whether the patient case is an emergency case or not. If it is an emergency case,

the physician will retrieve the relevant patient information from the system database.

Nevertheless, in general, the system can also request the examination queue for the

patient. Finally, after the patient has completed the medical check, the system will place

the medicine order to the pharmacy unit and update the information of the patient record

(Tang et al., 2001).

2.5 Patient Appointment systemA patient appointment system or appointment schedule for health care center

started long time ago. Management of patient appointments has earlier works and has

developed simplified queuing models and fairly static scheduling conditions. Another

attempt was made to calculate the waiting time between patient and doctor using the

mathematical queuing models to minimize waiting time (Harper and Gamlin, 2003).

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However; traditionally the appointment system has considered that the doctor

time is more important than patient time. So an appointment system was designed to

minimize the doctor idle time but current designing of an appointment system is based

on decisive factors with respect to both the patient and doctor (Wijewickrama and

Takakuwa, 2005).

The patient appointment system has complex structures because it represents the

patient appointment time in the healthcare center and controls the patient waiting time

based on the type and the period of patient appointment (Harper and Gamlin, 2003).

Moreover, a patient appointment system is meant for:

i) Managing doctor time.

ii) Reducing patient waiting time

iii)Reducing doctor idle time.

iv)Reducing nurse idle time.

v) Improving the quality of service in the health care.

2.6 Managing Patient Appointment systemAccording to Dexter (1999), managing patient appointment system is a

computer application used to manage and reduce the patient waiting time in the health

care center. Some health care centers do not use any appointment system. So it has a

longer average patient waiting time than the health care center that adopts the patient

appointment system.

While patients can wait for more than one hour to be attended to by a physician

in a health care center, they also can feel that they are being disregarded and treated

unfairly. So when patients are given the time of appointment in a health care centre,

they can evaluate the quality of service in the centre (Dexter, 1999).


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Hence, developing a patient appointment process for health care center

necessitates the use of a sophisticated queuing model that captures much of the real

systems features (saving time, reducing idle time, etc). Therefore the appointment

schedule represents the real situation in the health care center faced by patient

appointment schedulers. On the other hand, the standard practice for scheduling and

processing patient appointments are based on the nature of treatments of the patients

and that better approaches more sensitive to patient needs are desirable (Rohleder and

Klassen, 2002).

According to Hall (2006) the success of a patient appointment system depends

on how the patient appointment can be managed. Therefore there are several approaches

to improve the management of patient appointment. They are:

a) Enforcing the continuity of patient care.

b) Increasing the effectiveness of each appointment.

c) Reducing the demand for face-to-face patient physician interaction.

The continuity of a patient health care can be improved by reducing the

unnecessary appointments, once the patient is attended by a physician, who did not treat

patient in the previous visits. The probability for extra appointment is increased. In

addition, once the patient requests an appointment, the schedule is checked for any

appointments and/or some predictable appointments in the future. Thus, a single

appointment can be used to attend to multiple patient needs. An effective manner for an

appointment request is through phone call and/or email. Through this means, the patient

need not worry about getting an appointment and need not go to the health centre

personally to make an appointment, thus saving precious time. Moreover, using the

email or phone for direct interaction between the health care centre and the patient

enables also checking test results, appointment reminders and other services

(Hall, 2006).


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In the same manner, in some appointment systems, the patient appointment is

scheduled directly by the primary care provider in the health care centre at the

beginning of each month. All appointments of new patients are also scheduled in the

health care centre. The patient could mail a letter containing explanation of the purpose

of the appointment to a health care center and requests for information on the

procedures of health care, primary care providers and the attendance time. Generally the

schedule is set between two or four weeks. After the patient has visited the health care

center and is already charged a fee for treatment, patient can then make another

appointment. In addition, approximately 10 patients are scheduled for each clinical

session. The patient registration is done by the nurse, who has to give information to the

patient about procedures in the health care center and collects patient information,

which are then entered into the patients medical record (Jain and Chou, 2000).

One application developed to manage patient appointment scheduling has used

exponential enter arrival times. This model assumes that the exponential enter arrival

times could not be directly validated by date, and it is limited due to the nature of the

appointment scheduling. Since appointments are scheduled in the future, the exact

model of call arrivals will only have limited impact on measures related to the time

between the call and the appointment time. For this reason, the challenge for making

appointment system is designing a suitable system based on the health care procedure

environment. Hence, the appointment provider in the health care center can schedule a

patient into an appropriate time slot on a given day (Rohleder and Klassen, 2002).

Klassen and Rohleder (2004) have developed another method for managing

patient appointment using multiple schedule appointment in multiple period

environments. Patients can call for any appointment time but if the period time is full,

they should replace the appointment to another time.


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Moreover, various combinations for multi appointment and double booking are

measured and recommended for different operational use depending on the heath care

environment, because the varying appointment request has little effect on appointment

system performance especially maintaining acceptable performance, except when the

system has the overloaded option.

Many studies about patient appointment have found that there are rules or

policies for scheduling appointment system such as no scheduling for more than 20 or

30 clients and the best schedule is to place two patients in the first appointment and

spread the rest consistently over a period based on average service times. On the other

hand, a patient can call for an appointment without knowledge of the type of

appointment and appointment queue number and patient is not aware whether the

appointment is variable or not. Sometimes the exact duration for each patient can be

known but at other times this is unknown (Klassen and Rohleder, 2004).

Giachetti et al. (2005) have observed the process for patient flow, from the time

they arrive at the health care center until they are discharged and designed a patient

appointment flowchart as shown in (Figure 2.5), giving more explanations about the

patient appointment process.

a. Patients are checked in the scheduled appointment by a Patient Care

Assistant (PCA). Patients, who arrive after 15:30 are not allowed to check-

in. They have to leave the clinic without being treated.

b. After the patients have checked in, they are given identification numbers.

c. Then they have to wait in the waiting area. Meanwhile, the PCA prepares the

charts for the checked-in and places them on a table.


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d. A nurse retrieves the charts to call in the patient for preliminary assessment.

If a patient is a follow-up (not first visit) then patient does not require a

preliminary assessment.

e. Once the preliminary assessment is performed, the patient returns to the

waiting area, and the nurse places the charts on the disposition table for the

doctors.

f. After the doctor has treated the patient, patient gives the (patients chart) to

the PCA.

g. The PCA enters the patient information into the computer and gives the

patient the next appointment date as needed.


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Figure 2.5 Patient appointments Flow Chart.

(adapted from Giachetti et al., 2005)

Through observation of this process, the patients appointment is not a strictly

first-in first-out (FIFO) process. Once the patient is checked in, the appointment process

is done upon ordering of the patient charts. If the charts get shuffled out of order then

the FIFO processing is upset. Moreover, a physician will skip over a patient if the

patient is a follow-up of another physician. This is done for clinical reasons called

continuity of care (Giachetti et al., 2005).

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Another system developed by Mustafa, (2004) allows a registered patient,

having user name and password, to access and explore the list of physicians

alphabetically and select a physician, whose email contact and profile are also provided.

A patient can also view the physician working calendar to find out his/her working and

non working day to make an appointment. When the patient selects View Calendar

(Figure 2.6), the patient can then choose any valid day in any month to make an

appointment (Figure 2.7). After that, the patient will receive an e-mail from the system

to confirm the appointment time or to inform the patient that the selected time is already

taken by another patient or blocked by the physician.

Figure 2.6 Information about physicians

(adapted from Mustafa, 2004)

Figure 2.7 Appointment time table

(adapted from Mustafa, 2004)

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In general, the patient appointment system provides all the choices and the

capabilities to the patients, such as selecting a physician, selecting the time of

appointment, and allows them to access the health care system day or night and

schedule their own appointments using the Internet without spending time holding for a

nurse or having lengthy phone calls (Mustafa, 2004).

A study by Wijewickrama and Takakuwa, (2005), mention that the health care

operating time (due time) is from 8:30 am to 5:30 pm during the week days. Throughout

this period, four types of patients arrive to have a consultation appointment in the health

care center-appointed patients, same day appointment patients (walk-ins), patients who

come for a medical test and new patients.

Therefore, for the patient flow in the appointment system as depicted in

(Figure 2.8), new patients will have to go to the reception for registration (filling-out the

application) and other patients may have to go to the reception to check whether they

have to submit some requirements such as insurance care. Patients, who have

appointments are given priority over those who walk-in for consultation. Consequently,

these latter patients have to wait a long time in the waiting room to meet a doctor even if

the consultation time only last few minutes (Wijewickrama and Takakuwa, 2005).


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Figure 2.8 Patient Flow diagram

(adapted from Wijewickrama and Takakuwa, 2005)

Harper and Gamlin, (2003) studied the methods of managing patient

appointments in health care centers to reduce outpatient waiting times by improving the

appointment schedule. They made several schedules to do this process. The aim ofthe

initial step was to find out the balanced number of patients arriving every 5 minutes, for

instance, between 14:00 and 15:40 and all the extra patients would be scheduled

between 15:45 and 16:00. The patients are arranged in booking blocks, which have

different sizes according to the type of patients as follows:

a. Follow-up 3 every 20 minutes.

b. Extra 2 every 30 minutes.

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c. New 1 every 15 minutes.

d. Urgent 2 every 30 minutes.

e. Ward discharge 1 every 30 minutes.

This block appointment contains also buffer periods (15 minutes) for patients

without booking. Hence, for the system flexibility, the appointment time between 15:35

and 15:45 is kept free. This process of managing patient appointment is based on an

algorithm, which spreads among the appointments based on clinical sessions, for

instance, using the time between 14:00 and 16:55 for patients, who are in the schedule

but not in the block appointment. The algorithm below has considered this process

(Harper and Gamlin, 2003):

a. Choose the patient type, except diary patients, with the largest average consultation

time.

b. From the patient type, schedule individual patients in every available appointment

slot, determined by total number of patients divided by the total number of

appointment slots, in the clinic sessions.

c. If no patient type remains to be allocated, go to step (vii).

d. Else, if there exists patient types not previously located, choose (i).

e. For the clinic under consideration, calculate the total number of patients booked for

each time duration and identify the largest consecutive cluster of time duration, that

contains the minimum total number of patients booked.

f. Scheduling a patient in the middle of the group. If the group contains a numbers of

times, scheduled the patient in the earlier of two middle.

g. If there are still patients of this type, which need to be allocated then, go to step (iv),

Otherwise go to step (iii).

h. Stop.


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Porta-Sales et al. (2005) have developed another system. The main concept of

the system is contacting, screening and scheduling appointment with the health care

center initially by an expert nurse and the patient initiating contacting with the health

care center using the telephone. Moreover, the health care center can be accessible from

different places. So there should be PC resources and PC consultations to be accessed

from different sources, from other hospitals, from general practitioners, or even from

the patients themselves (see Figure 2.9).

Figure 2.9 Patient Flow diagram

(adapted from Porta-Sales et al., 2005)

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Porta-Sales et al. (2005) studied 534 patients for a period exceeding one year.

After the first visit, 195 patients did not return for the second scheduled appointment

and 203 patients had progressed on to the third scheduled visit. The main reason given

for the scheduled visits was admission into the health care; the median time-lapse

between the first and second visit was 21 days, between the second and third was 27.5

days and between the first and third was 48 days. Comparing patients, who did not

attend the three consecutive visits with those who did, indicated that the former had (at

the first visit) a lower performance status.

According to Guo et al. (2004), the patient appointment is a process performed

by customer service representatives in call centers and the schedules are assigned to

incoming requests for appointments but the main problem in determining the

appointment is the randomness of patient demand. For outpatient scheduling

appointment system, there are four components detailed below:

a)

External request for appointments

Once a patient calls to request an appointment, the request is taken by the system

appointment model. Patient calls are organized into types of appointments (Table 2.1).

Calls are usually different day to day, and the requests for appointments sometime are

for specific time periods (e.g. weeks or months) in the future. In addition, the type of an

appointment depends on the patient request, whether if it is a specific type or not.

Table 2.1 Appointment Type

(adapted from Guo et al., 2004)

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b) Patient Flow LogicPatient Flow Logic is a sequence of appointments (Table 2.2). The historical

data is used to determine the appointment. Often the patients prefer to see the same

doctor for each visit to the clinic and new patients would like to get early appointment

times. Follow-up appointments are sometimes scheduled well in advance of the actual

date.

Table 2.2 Basic Patient Flow Logic

(adapted from Guo et al., 2004)

1.Arrival of new patient call

2.Patient characteristics are drawn from distributions (appointment type,

insurance.)3.Appointment is scheduled

4.Delay until appointment day

5.Does patient show up for appointment? If not, go to 6, otherwise go to 7

6.Does patient call for rescheduling? If not, exit, otherwise go to 3.

7.Does patient need a follow-up appointment in the same appointment

category? If so, than go to 8, if not then go to 9.

8.Delay until patient calls for follow-up appointment, than go to 3.

9.Does patient need a "regular" follow-up appointment? If not then exit

system.

10.Delay until patient calls for follow-up appointment, and then go to 3.

c) SupplyIn practice, schedules providers are determined by templates, which are

essentially daily specifications of the number of appointments for different types of

appointments. This accommodates different productivities of the providers as well as

different specializations, which will result in different proportions of appointment types

attributed to various scheduling requirements, such as vacation time, research time, and

other commitments.


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d) Scheduling RulesComputerizing the schedule moves the scheduling operation to the call center,

through a specific model, assigned to a patient appointment request. The main principle,

currently used by the schedulers, is the level of urgency of the appointment. It

determines the scheduling flexibility whether or not an appointment may be over

reserved and whether the appointment is specific to a particular provider, any available

doctor should provide the necessary care.

Su and Shih, (2003) have studied in a private hospital, which has several clinics.

For each clinic, the average patient load is 20 per consultation section (morning or

afternoon) and the health care system adopts both a patient appointment model and

patient registration model. The system allows patients to have self-selected specific

physicians for consultation and registration.

The management appointment system studied by Su and Shih, (2003) is based

on the first 20 reserved for scheduled patients, after that, only seven are offered for

scheduling. Odd numbers after 20 are left for walk-ins. The arrival time of the first

patient is assumed to be the same as the clinic starting time. The scheduled patients are

assigned based on 3- main intervals and are also informed about their appointed arrival

times (see Figure 2.10).


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Figure 2.10 Patient processes in the clinic

(adapted from Su and Shih, 2003)

If the scheduled patient does not appear on time, the next available patient

receives consultation immediately. The management operating philosophy of services

here is based on first in, first seen to limit patient waiting time. Therefore, a patient

can walk-in to see a physician, when patient shows up at the appointed time (Su and

Shih, 2003).

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Ellingsen and Obstfelder, (2006) studied on Individual Action Implementing

Electronic Booking System. The system refers to the patient's appointment, when

patient arrives at the hospital for examination and/or treatment. Traditionally, the patient

must have an appointment. Determining the appointment depends on the hospital

resources and the patient current condition. When the decision of an appointment time is

made, the patient is informed by mail with the hope that it suits the patient. The

implementing system here is to solve this problem through establishing a flow of

patients through the health care system by giving the opportunity to a patient to choose

a suitable date and appointment time for them.

A web-based booking application to help the patients to get an appointment can

be developed. Once the nurse decides that the patient needs an appointment, the nurse

logs in the web-based booking application using both username and password and then

specifies the appointment time. Ellingsen and Obstfelder, (2006) have developed a new

concept to facilitate two or more systems in the health care center such as electronic

patient record and electronic booking application. They incorporated the electronic

patient record and electronic patient record in the same system when a patient needs to

enter their particulars, where there is special page for this purpose (see Figure 2.11) and

when the patient want an appointment they have to log in the specific page in the

appointment process (Figure 2.12).

Figure 2.11 Patient information for registration

(adapted from Ellingsen and Obstfelder, 2006)

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Figure 2.12 Patient appointments (electronic booking)

(adapted from Ellingsen and Obstfelder, 2006)

Aiello (2005) worked on the patient appointment system in an army primary

care clinic. It is an Open Access Appointment System. There are three classes of

appointment systems in the army primary care, with each having different types of

appointments:

i) The traditional access system: patient has to call the clinic for an appointment and

depending on the patient medical need, patient given an appointment type and time.

ii) Predictable request for appointment: Patient, who calls earlier, will benefit from

confirmed appointment, whereas the patient, who calls later, will be placed in an

unconfirmed future date.

iii)Nontraditional appointment approach: the patient is asked `Do you want an

appointment today? and who is your preferred physician? Then, the patient will

define and control the appointment process.

In managing patient appointments in the army primary care, normally, there are

nine types of appointments. Once a patient calls for an appointment, patient will be

placed into one of the nine appointment types. Many clinics in the army are establishing

this service to handle the inability of patients to receive the same day care. The open

access method is a solution for patients, who is unable to see the nurse for the second

appointment and this reduces the current backlog of clinic appointments until every

patient is able to accept the same day appointment.

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Kopach et al., (2007) has developed a system, where the appointment can be

made many months in advance. Once the patient wants to have an appointment to see

the physician, they just have to call the health care informing the preferred date and

time. If the appointment slot is available within a day or two of the preferred date, the

patient appointment is then scheduled. If not the patient has to call back later;

(Figure 2.13) shows this concept, which balances between the request of appointment

and the clinic capacity. This has improved patient access to physicians and reduced

uncertainty in the health care operations by eliminating no-shows, resulting from long

appointment times. In addition, in static appointment, all decisions about appointment

times are made prior to the start of a session, but in the dynamic case, the appointment

times are adjusted as patients arrive.

Figure 2.13 Patient appointments process

(adapted from Kopach et al., 2007)

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There are three parameters in the appointment system - the block, which is the

number of patients arriving at the beginning of an appointment period; the initial

block, which is the number of patients arriving for the initial appointment; and the

interval, which is the length of the appointment (Kopach et al., 2007).

2.7 Critical analysis for previous researchBased on the literature review (see Table 2.3), all the previous studies are

targeting to do some or all of the following:

Improving the quality of health service.

Managing patient information in the health care.

Managing the patient appointment.

Reducing the patient waiting time.

Providing the easy way for patient health.

Keep tracking for patient information.

On the other hand, those studies come out with one or both of the following points:

a) Analysis: some of the previous studies were targeted to analysis the currentsystem use in the health and find out the points that can help to improve the

performance of health care system and improve the quality of health care.

An analyses aim was focusing on the steps of patient treatment and

consultation. In addition, managing the patient appointments and focusing on

reducing the patient and doctor idle time. Therefore the results of those

analyses were Patient treatment and consultation flow chart and Patient

appointment flow chart (see Table 2.3).

(Giachetti et al., 2005), (Wijewickrama and Takakuwa, 2005), (Porta-Sales et

al., 2005), (Guo et al., 2004), (Su and Shih, 2003) and (Kopach et al., 2007).


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b) Developing health care system: some of the studies were targeted to comeout with a health care information system, such those systems were

developed based on the user requirements and or based on the system needs.

The main point here is the health care has much information that needs to be

managed such as patient information, medication history, appointment,

doctor schedule, health care document and payment and so on. Therefore the

researchers followed a different method for developing those systems (see

Table 2.3).

i.Application: Computer application developed as a client and

server in entrant network. This type of application can manage

the health care information and it helps to automate the health

care information. Such an application was developed by

Laserfiche (2007) and Rohleder and Klassen (2002).

ii. Web-based: Its a health care website is linked to an

interactive database. This system can be accessed as a normal

website because it's been developed to be work based on the

web browser. Such a Web-based was developed by (Wald et

al. (2004), Lindemann-v (2002) and Lim et al. (2006).

iii. Website: It is a health care website and the patient can review

and register online through it. Such a Website was developed

by Ciminoa et al. (2000).

iv. Email: Used for sending messages from the health care staff

to the patient to inform them about new appointments or any

announcements and the patient can send to the staff regarding


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any inquiries. Such these service used in a system developed

by Mustafa (2004).

v. Telephones: The traditional way for connecting between the

patient and the health care staff. The patients use it for

booking appointments or confirming appointments or any

other inquiries. Such this system an integrated with computer

application. This system has been developed by Porta-Sales et

al. (2005).

vi. Blocks: This means dividing the patients to groups. This way

its a result for analysis study has been done by Harper and

Gamlin (2003).

vii. Multiple methods: Some of the researchers use multiple

methods for developing health care system to get the benefit

of each method. Such as Application and Web-site by Chua

(2005), Mazzi et al. (2006) and Aiello (2005).


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Table 2.3 Critical analyses, system features and types for previous studies based on the

literature review

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Based on the previous study, and analysis done in section 2.7 the conceptual

framework based on the literature review in an integrated developed system show on

(Figure 2.14). In addition the conceptual frame works for the appointment system (see

Figure 2.15).

Figure 2.14 Conceptual framework for health care system based on the literaturereview

Figure 2.15 Conceptual framework for the appointment system based on the

literature review

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Table 2.4 Limitation and strength of the health care system based on the previous study

in the literature review

Strengthof health care system Limitation of health care system

- Improving the quality of service inthe health care (Laserfiche, 2007),

- Using the system online andallowing the patient to view their

profile online (Lindemann-v et al.,

2002).

- Integrated health care system (Limet al., 2006).

- Patient can choose the physicianand the appointment date online

(Mustafa, 2004).

- Using the call by phone to interactbetween the patient and the nurse.

- Using the online manner to supportthe health care application.

-

Dividing the problem of managingthe appointment into small blocks,

which help to find a good solution

(Harper and Gamlin, 2003).

- Most of the systems are notintegrated system (Mazzi et al.,

2006).

- Some of the systems developed tomanage part of the health care

information (Mazzi et al., 2006).

- All the applications hold aroundthe appointment problems and did

not give enough mention about

conforming the appointment

(Mazzi et al., 2006).

- Confirmation the appointmentusually using the call by phone

(Porta-Sales et al., 2005).

- Using the email for booking andconfirming the appointment, whichis some time not suitable for some

patients (Hall, 2006).


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2.8 ConclusionInformation system is a technology used to deliver the right information to the

right person at the right time in any fields of business. Essentially, the system is an

arrangement of information technologies used for capturing, storing, and distributing

data to meet an organization's needs. This includes computer hardware, operating

system and application software as well as telecommunication and networking

technologies.

In the health care information system, the importance of an information system

has originated from the need of keeping tracking of patient information efficiently. The

Health Care information System is the preservation of individual patient information to

represent their health information history and provide the flexibility and accessibility for

patient information to be more reachable by authorized personnel. On the other hand,

managing patient appointment is a computer application used to manage and reduce the

patients waiting time in the health care center. This means a patient appointment

system uses a sophisticated queuing model, that captures much of the real systems

features.

Traditionally, determination of patient appointment is dependent on the hospital

resources and the patient current conditions. So, when the decision of appointment time

is made, the patient is informed by mail, phone, or other means with the hope that the

appointment time satisfies the patient. Therefore, developing a software or application

for solving the health care problems has to consider several aspects of the problems.

Based on the literature review, and the critical analysis done in section 2.6 there

are some points of relevance to be considered:

i. The proposed health care information system should cover every single aspect of

administrating and managing health care.


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ii. In using the information system, for managing the health care information to

improve the quality of health service.

iii. In using the information system, the patient is given the opportunity to use the

system and access his/her information.

iv. In using the information system, the patient can access the appointment

possibilities and chose the suitable time.

2.9 SummaryThe literature review dedicated to review what the previous researchers have

done to improve the quality of health care. In this research, the objectives focuses into

analyzing the previous studies and the current systems use in the health care, then

design and develop an integrated health care system for managing the patient

information and tracking the patient information history. In addition, provide very

secure and sturdy communication between patients and physicians.

Hence, a general information about health care information system has been

presented to give briefing about definitions and significant of health care information.

Then the next part present the health care management system, patient appointment

system, managing patient appointment system, which reviewed the previous studies that

explained several methods for managing the health care information and the patient

appointments. Finally, it is the critical analysis part for the previous studies, which

present the features of each study and the result is conceptual framework and

comparison between the limitation and the strength of each study. The next chapter is

the research methodology, which describe the method that use to implement this

research.


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CHAPTER 3

Research Methodology

3.1 IntroductionResearch methodology is a guideline for application development. It provides an

overview of the methodology flow and the research methods to be used to achieve the

aims of the research. The purpose of using research methodology is to solve the

research problem or problems and achieve the aims of research (Dawson, 2002).

This research aims to develop an integrated health care computer application to

manage the entire patient information such as medical history, consultation history,

treatments history and patient appointment etc. Therefore, the objectives focuses into

analyzing the previous studies and the current systems use in the health care, then

design and develop an integrated health care system for managing the patient

information and tracking the patient information history. In addition, provide very

secure and sturdy communication between patients and physicians.

This chapter highlights several points started by chapter introduction, the

research strategies, data collection and highlights of the research respondents, the plan

of data collection and emphasizes on the data analysis framework, and finally focuses

on the way of system development.

3.2 Research StrategyThe concept of this research strategy comes from analyzing the literature review

that proved the current health care information system is not completely comprehensive

and each researcher focused only in part of the health care information system and there

is a lack of the integrated health care systems that can fulfil the patients need for

medical information.


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So, this research aims to provide a proper academic solution through following

the research methodology structure. Therefore, this chapter starts by research strategy,

which is describing the way of implementing the research study.

Hence, the adopted research strategy is presenting the finding from analyzing the

previous studies in chapter two and supports the result by adopting case study from the

real live, which is typically observing the characteristics of the research respondents,

how they are doing their work, because the adopted strategy is proving the credibility

results of analyzing the previous studies.

Therefore, the research respondents should be staff member in a hospital who

uses a health care management system and patients in hospital for medication purpose,

because the staff member they are daily use the current health care system and they are

familiar with the system environment. So these people absolutely know about the

limitation and /or problem in the current health care system. Conversely the patients

may have suggestions which could helps to enhance the quality of health care especially

with the aim of all the health cares are targeting to deliver a very good health services to

the patients.

However, the reason of using such strategy is for achieving the problem

statement of this research needs to study and analyze the finding from the literature

review and the current health care system, which is requiring the implementation of

empirical research. So using a case study is approaching facilitates for this research and

drive to probe deeply into a health care responses through interviewing the respondents

in both hospitals (UH and HUKM). The interview was by asking the respondents

several open questions, those questions are arranged in sequence started by the current

system use in the hospital and then the respondents suggestions about the new system,

then the respondents answers written as notes under each question asked.


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3.3 Data CollectionOnce the research strategy has been adopted, the next step, method of Data

collection is required, which is containing description of the research sample

(respondents) and the sample technique, and then the data collection technique

(interview and observation).

In this research data collection is from two public hospitals (UH and HUKM),

because those hospitals are big, public and daily hundreds of patients come to the

hospital for medication. So definitely the management of hospital they are facing

problems for managing the patient information and managing the patient appointment.

In addition, they are using non integrated health care system for managing the patient

information. Furthermore, these hospitals are academic hospital, which have a good

environment to conduct such academic research.

3.3.1 Data Collection Techniques

Data collection is a technique, that allows researcher to systematically collect

information about the study population (people objects, phenomena etc) and the setting

in which they occur (Biggam, 2008).

Likewise, collection data in this research goes through the interview because the

individual interview is straightforward to get the information from the respondents

(doctor, nurse and patient) and this resear