Tech

Online Doctor Appointment Management System

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January 11, 2019

With the advent of the technology, there has been a radical change in the way the world goes around. The healthcare system is no exception. Information Technology is being utilized to bring about rapid changes in the healthcare industry, and these changes have affected the medical professionals and patients alike. In fact, the medical industry has used the evolving technologies to tap into previously untapped areas to improve the quality of care offered, and make it easy for the care providers (doctors and healthcare personnel) to optimize their services for patients.

One such service used by medical professionals is Online Doctor Appointment Management System. It is an emerging healthcare technology solution that allows a patient to contact a doctor and schedule an appointment as per their needs using the internet. This system also allows the patients to keep track of their appointments using features like Calendar, Reminder or Alerts, SMS/e-mail Alerts, etc. This helps them to keep their appointment and reduces the number of “no-shows” in the clinics or hospitals. These services, sometimes also referred to as Online Appointment Portals, eliminate the gap between patients and doctors. They give patients the flexibility to book their appointment with the doctor in their neighborhood.

Features of Online Appointment Management system:

Online Appointment Scheduling System can be a part of a larger-scale Medical Practice Management System (PMS) or can be a web-based system, called Software-as-a-Service (SaaS).  While medium to large medical offices and establishment have the option of online appointment scheduling provided with the PMS software that they use, small medical practices or solo practitioners may not have the cash or capacity for a full-appointment scheduling system or electronic medical records. For such instances, there are certain providers who provide SaaS, where a license can be purchased for their Online Appointment Management Software, without having to invest in expensive software such as PMS. Today, on the internet, there is free Software available as well, that fulfill the basic requirement of Online Appointment Management.

Technology

The Appointment management software fall in two categories: Desktop applications and web-based systems. The online appointment management software is included in the web-based systems, which is provided by a third-party service provider in the form of appointment scheduling tools and features, usually via a web browser. When using an online doctor appointment portal, the patient gets the choice of booking their appointment according to their convenience. On the doctor’s end, the system automatically confirms the appointment if the slot is previously approved, and the booking is recorded in the system. And there is no staff intervention needed throughout the process. This has the benefit of customers having the choice of booking their own appointments using the portal, versus the traditional walk-in registration at the clinic or hospital.

Nazia S. and Ekta Sarda, in their study Online Appointment Scheduling System for Hospitals–An Analytical Study, proposed that architecturally, the system can be defined using a 2-tier model.

  • The first tier, patients can access appointment information with a web-browser through the Internet.
  • The second tier consists of:
    • a web server that connects to the internet,
    • a portal server, that processes user registration and login requests, and
    • an application server, that manages the complete end-to-end appointment tracking and scheduling services.  The key functions of application server include: (1) multiple-practitioner scheduling, (2) centralized and consolidated patient appointment tracking, (3) available appointment searching, (4) appointments rescheduling, and (5) appointment confirmation and cancellation.
  • The first tier is connected to the second tier for information exchange by the web services.

The architecture of Appointment Management System:

Components

A system is a set of components working together as a part of a mechanism or a network in order to achieve a specific objective. Similarly, a web-based appointment booking system can be defined as a system that can be accessed on the internet by a user in order to achieve a particular task for a given purpose, in this case, to schedule an appointment with a doctor and manage it thereafter. The Medical appointment booking system has 2 set of components, namely-

  1. Server or administrator side, which includes data management functions like- to add, delete, modify, query, restore and backup the database.
  2. Client-side, that runs on the browser, and provides online registration functions like register and log-in, select department, date, doctor and other bookings.

An integrated online patient appointment scheduling approach based on Web-Services architecture enable the advancement of patient-centered health care system as well as makes it easier to execute their goal seamlessly. The architecture is structured to allow users to make use of portable computer system, desktop computer system, and mobile phone as a web browser to access the booking system.  The goal of automated patient appointment scheduling process is to integrate distributed clinical systems into a set of consistent and convenient services accessible via a web browser. A Web-based Medical Appointment scheduling system can be depicted as follows:

Considerations before Implementation

A variety of online Appointment Management applications are available on the market today. However, they vary in the types of features, functionality, and services they provide. Common considerations include:

  • Requirement or Choice- Before implementing any Online Booking system, it is essential for the medical facilities or professionals to ascertain whether it should be made the only mode of appointment or should it be kept optional. Making it the requirement may reduce the staff burden, but it might pose a problem to the patients, who lack web access or do not understand it.
  • Professional Services– The scheduling needs of every medical and healthcare facility are unique and might not be covered under a standard scheduling package. Hence, the pliability of the system to accommodate the dynamically varying needs of the enterprise must be accessed before implementing. This is important in the case of an institute with multiple locations, larger staff, and a high volume of appointments, where there may be a heavy load on the computer system.
  • Features & Functionality- Depending upon the type and budget of the enterprise, an analysis of both current and future needs should be done prior to implementation. This analysis should help in deciding the extent of advanced features and functions that the provider has to offer, along with the basic features that are common to most systems.
  • Cost- The cost of an online scheduling system for medical facilities is determined by the scope of the operations and what the software will be used for. For instance, small medical practices or solo practitioner will require only a basic set-up along with some nominal monthly fee. There are also free web-based software available today. On the other hand, a larger facility may require a more professionally advanced service, thus incurring a higher cost of implementation.
  • Security- Security is one of the most important aspects when it comes to any online system. Reputable providers incorporate the latest security measures and practices, such as secure server databases, data storage, backup procedures, processes related to failover and federal regulations to ensure the safety of the healthcare data.
  • Dependability- Longevity is usually a good tell-tale sign of a dependable service provider. The longer the provider has been in business, more dependable are the services. Feedback from other facilities can be obtained to make a decision.

As far as the System requirements are concerned, all web-based systems that are available as a SaaS are user-friendly and do not need any special platform training to use them. The most basic requirements of such system are a Web Browser along with a secure, high-speed network (internet), which are easily accessible and affordable. The client (doctor), however, needs to buy a subscription or a license to avail the services. These services are compatible with almost all PCs, portable computers as well as smartphones available nowadays.

System Usage

Online Appointment scheduling system lies at the intersection of providing efficiency and timely access to health services. It has its usefulness on both the ends, i.e., the doctor (client) and the patient (customer).

  • For Doctors- The system provides the following useful features:
    • Schedule daily appointment lists of patients
    • View patients complete information before arrival
    • Assign time slots to various patients on the basis of similar data like a new or long-term patient, complaints, specialization, etc.
    • Save no-show appointments information
    • Maintain canceled appointments information
    • Send Reminder SMS or email alerts to the patient
    • Save patients’ data for future reference, securely
  • For Patients- The system has the given services:
    • Find the doctor with the required field or specialization
    • Track a doctor’s location, availability, and number of clinic hours
    • Book an appointment as per their own convenience
    • Review or cancel the appointment
    • Provide basic information and chief complaints prior to the visit

Appointment Tracking and SMS Alerts

Apart from online scheduling of appointments, the system also has the provision for Appointment tracking, which means the system maintains the records of the appointments including any rescheduling, cancellation (with or without reason), reminders sent, information shared between doctor and patient before and after the appointment, and the outcome of the appointment. These recording and record-keeping capabilities make it quick and simple to access data associated with a specific appointment.

Most web-based systems also provide automated e-mail and text message alert, which go through the system to the patients and booked individuals before their scheduled appointment. This helps in reducing the “no-shows” and number of missed appointments. The patient no-show problem results in underutilization of clinic capacity and causes loss of revenue. A study conducted by Pare G. and colleagues has shown that such automated reminders help significantly reduce the “no-shows”. It also eliminates the scope of human error introduced in various stages of conventional appointment booking systems.

Benefits

Widely, benefits of online appointment system can be classified into three broad categories depending upon the group of users making use of the facility-

For Doctors-

  1. No Time Constraints– Doctors can handle appointments anywhere, anytime. The system allows doctors to fill in their availability, location and time as per their convenience, hence saving a lot of confusion and time. These slots can be arranged and re-arranged a  number of times according to their needs.
  2. Early Career Boost– New doctors can get a boost to their budding career being a part of the online services as the system is unbiased. Also, they can get feedback for their profile by requesting it from patients after the appointments. This helps in establishing a good profile that spreads around.
  3. Easy Record Maintenance- All the appointment can be aggregated from the website, phone inquiries or direct inquiry. All the patients’ files can be linked to patients’ online profile. Also, this saves a lot of paperwork and provides an easy and error-free way to keep the patients’ records and history secure, for future reference.
  4. Customizable-There are various applications available that are easy to scale and customize as per clinics/Hospitals requirements.
  5. Sharing Knowledge– Certain applications may incorporate blog writing where the client (doctor) can also share knowledge on health care publically to give out information which might be useful to many patients.

For Patients-

  1. Information and Review- Patients can access information about doctors in their area. They can also get reviews about doctors, their experience in the area of specialization, their consultation fee and various other information. They can also help other people find the right doctor for their requirements and purpose of illness.
  2. Flexibility to the Patients– Convenient and secure to book appointments and reservations online through any Web-connected device, such as a computer, laptop, smartphone or tablet. In general, the patient appointment system enables the patient with an array of choices and options, such as appointing a physician, selecting appointment-time, accessing the health care system at any time of the day or night and book their own appointments using the Internet without spending time on manual intervention by a  nurse or worse; having extensive phone calls.
  3. Convenient to New or First time users– Anyone who is living in an unfamiliar locality need not worry about getting to know about the best Hospitals and doctors around the place as Online Appointment System is unbiased and gives out even results for all user.
  4. Spatial Access to the facility– As everyone is concerned about saving time nowadays, online appointment system can come in handy for those who are willing to visit doctors in a nearby location. Also, they can view the doctor’s locations on the map for navigation purposes while fixing an appointment or visiting the hospital or clinic.
  5. Helpful Search Filters-People can search by Doctor’s Name, Practice Name, Hospital Affiliation, Region, Specialization, Insurance.
  6. SMS Alert benefits and Feedback System-System’s automated reminders help significantly reduce the number of missed appointments. Also, patients can provide their feedback as well as suggestions on the call which are significantly recorded to make the user experience better.
  7. 24-Hour ConvenienceScheduling appointments over telephone often require an individual to phone in during conventional office hours, as few facilities offer round-the-clock phone booking. This is an inconvenience for the most individual as it coincides with their work hours. Additionally, many people prefer online scheduling rather than over the phone or in person because of the sheer ease of use that the system provides.
  8. Online Payment FacilityIt is really of great ease to the user if the online Application System provides a Fintech solution for payment or a payment gateway which allows them to pay the consultation fees or if they wish to place any recursive payment routine for any particular service they are opting.
  9. General Awareness and Learning– Healthcare education videos made by experts are sometimes incorporated in these systems for general awareness of users which can benefit them in every sense.

For Hospitals-

  1. Time savings– Quite simply, the time saved from spends less time on managing the appointments is a big benefit for the service providers. The online process not only saves the time of the staff but also, it frees up doctors’ time by streamlining the whole procedure.
  2. Monetary Savings– As the old saying goes, “Time is Money”. Time savings convert directly to monetary savings. As staff resources can now either be freed or utilized doing other tasks. It eliminates the need to hire new staff members to handle the workload created by the appointment-scheduling process.

For example- At a large medical facility that typically schedules approximately 100 appointments daily, each appointment call is fielded by a support staffer, who spends approximately 4 minutes on the telephone. This amounts to 400 minutes of time spent each day just to schedule appointments over the phone. This is the amount of time saved just from avoiding taking phone calls. Several other tasks are also automated by an online scheduling system, such as automated appointment reminders, add additional time savings to daily operations.  The time savings experienced by a facility can translate into monetary savings, and the savings could be quite significant, as an average yearly salary of a medical office administrative assistant is $36,000

Limitations

In a study conducted by MinMin Zhang and colleagues in China (2009), it was found that even though the web-based appointment systems provided a much more convenient booking method, only 17% of patients used it. And the same has been observed in a number of other studies, particularly in developing countries. Thus, it is important to speculate on the limitations of an Online Appointment scheduling system, such as-

  1. Skewed Patient Demographics- This kind of online facilities depends largely on patients demographics. It can be a hindrance to those without easy access to the Internet or who prefer to schedule their appointments over the phone. In the above-mentioned study in China, being ignorant of online registration, not trusting the internet, and a lack of ability to use a computer are three main reasons for not using the web-based appointment system. All these factors may result in a high influx of a certain demographic whereas low influx of the other. This can be extrapolated to most of the developing world, where technology growth is still very slow.
  2. Technology Dependent- On the technology side, the appointment system selected should include security and privacy policies Safety of patient data is a sensitive issue. So a strong medium of trust needs to be established to win user assurance. You need to have a secured payment gateway and secured database servers to save user sensitive data.
  3. Online Security Threat- As the internet and any facility using web-based services are also prone to cyber-attacks. Therefore, users don’t trust online healthcare services to share their sensitive data.
  4. Technology gap- this kind of system has less chance of flourishing in developing countries for the present time, as less than 5% of the population on an average, has regular access to the internet. Perhaps the older generation, which is more prone to illness, can hardly utilize these services for several reasons including that they find it difficult to trust online services.

Future Possibilities

In developed countries, web-based appointment systems have been studied extensively, tested and verified, and then implemented across the medical industry. A number of studies concluded that compared to the traditional walk-in patient registration, online appointment booking has proved far more efficient and resourceful, especially in terms of reduced waiting time, decreased missed appointments and increased patient satisfaction. This can be attributed to the growing usage of the internet, not only among the youth but also in the older generations. A Pew Research Center Internet & American Life Project survey shows that-

Internet users ages 50-64 grew 88 percent—from 25 percent to 47 percent—from April 2009 to May 2010, while it grew 100 percent from 13 percent to 26 percent for those among ages of 65 and older.

However, the scenario in developing countries is quite different. Lack of access to the internet, skepticism regarding the use of online services and ignorance about the availability of such services has kept a check on the growth of web-based appointment booking systems. There are not enough studies conducted to clearly define the factors that are hindrances to the development of these services.

In the end, it may be concluded that an Online Doctor Appointment Management System helps in reducing the gap between doctors and patients, thus allowing the whole process to work seamlessly. The public demand for a better healthcare system and the number of missed appointments have forced the healthcare sector to recognize how they deliver care services. The conventional way of appointment booking is via fax, phone or email. But with the growing internet penetration, the healthcare industry is moving towards the use of an online appointment booking system. Online Doctor Appointment Scheduling systems present a win-win solution for patients as well as medical professionals.

References

  1. Cao W, Wan Y, Tu H, et al. A web-based appointment system to reduce waiting for outpatients: A retrospective study. BMC Health Services Research. 2011;11:318. doi:10.1186/1472-6963-11-318.
  2. Zhang M, Zhang C, Sun Q, Cai Q, Yang H, Zhang Y. Questionnaire survey about the use of an online appointment booking system in one large tertiary public hospital outpatient service center in China. BMC Medical Informatics and Decision Making.2014;14:49. doi:10.1186/1472-6947-14-49.
  3. Paré G, Trudel M-C, Forget P. Adoption, Use, and Impact of E-Booking in Private Medical Practices: Mixed-Methods Evaluation of a Two-Year Showcase Project in Canada. Eysenbach G, ed. JMIR Medical Informatics. 2014;2(2):e24. doi:10.2196/medinform.3669.
  4. Idowu, Adebayo Peter; Adeosun, Olajide Olusegun; Williams, Kehinde Oladipo. International Journal of Computer Science & Information Technology;4(Aug 2014): 59-73.DOI:10.5121/ijcsit.2014.6405
  5. . Ho, C., & Lau, H. (1992). Minimizing total cost in scheduling outpatient appointments. Management Science, 38 (12), 1750-1764.
  6. Kaandorp, G., & Koole, G. (2007). Optimal outpatient appointment scheduling.Health Care Management Science,10, 217-229.
  7. Klassen, K., & Rohleder, T. (1996). Scheduling outpatient appointments in a dynamic environment.Journal of Operations Management,14 (2), 83–101.
  8. Neal, R., Hussain-Gambles, M., Allgar, V., Lawlor, D., & Dempsey, O. (2005). Reasons for and consequences of missed appointments in general practice in the UK: Questionnaire survey and prospective review of MediCal Records. BMC Family Practice,6, 47.
  9. Daggy, J., Lawley, M., Willis, D., Thayer, D., Suelzer, C., DeLaurentis, P.-C., Turkcan, A., Chakraborty, S., & Sands, L. (2010). Using no-show modeling to improve clinic performance. Health Informatics Journal, 16 (4), 246-259.
  10. Nazia S., Sarda Ekta, Online Appointment Scheduling System for Hospitals–An Analytical Study (2014). International Journal of Innovations in Engineering and Technology (IJIET), 1 (Aug 2014), 21-27 ISSN: 2319 – 105
  11. The Benefits of Online Appointment Scheduling to the Medical, Healthcare and Wellness Industries (2012). Retrieved from: https://www.appointment-plus.com/images/pdf/online-appointment-scheduling-benefits-to-medical-healthcare-wellness.pdf
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Prahlada N.B
CHITRADURGA, KARNATAKA, INDIA 577501

Thank you very much for visiting my blog. I am an Indian and I am a patriot. My Vision: I don't want to be a genius. I want to be a person with a bundle of experience. My mission: Help others achieve their life's objectives in my presence or absence! My Values: Creating value for others. My main interests are climate change, water conservation, food for all, preserving natural resources, health, and hearing. I work in these fields relentlessly and fearlessly to make this world a better place for our next generation.