CHAPTER 2

2.0 LITERATURE REVIEW

This chapter discusses the review of existing systems and literary work by researchers.

2.1 TRADITIONAL APPOINTMENT SCHEDULING: Traditional doctor appointment

scheduling has a standard policy for patient to make an appointment in advance or few months
ahead of the actual date (Robinson & Chen, 2010). But with no patient reminders, there is a high
probability that patients will not show up for their appointments, leading to overbooked
appointment timeslots and increasing patient waiting time. It is recommended that a patient
reminder is vital to reduce patient no-shows.

Another traditional appointment scheduling is using paper-based system for the appointment
registration process. It will require patients to complete and submit appointment forms or place
identification card or appointment card in a specific box provided, waiting for their names to be
called during their turn

The drawback of this system is if patient or medical staff lost their appointment card or the card
is replaced by unauthorized patient, causing waiting time of patient to increase.

(Lee et al., 2013) shows that clinics has switched to an open access system in which patients will
share appointment time slots with patients wanting appointment on the same day to address
patient no-show problem. The clinic allocates three to four appointment slots for same-day
patients. However, this system is not effective when there is a large patient demand for a
particular appointment time slot. Patient also do not know which time slot has less patients.

2.2. ONLINE APPOINTMENT SYSTEM: (Robinson & Chen, 2010) stated that online
appointment registration and scheduling has been an alternative for patients to avoid the
inconvenience of queuing and filling out registration forms, which also allows hospital staff to
easily monitor and search for patients’ medical records or personal information as it is available
online. The inefficiency of the system is since it is accessible online, the risk of online hacking of
patient personal data is huge. Besides that, there is no reminder system for appointments.

Pantai Holdings Sdn Bhd (PANTAI) introduced an online appointment system which allows
patients to make a doctor’s appointment via the website.
There is a direct registration feature which allows patients to directly register themselves online
without having to queue physically at the hospital. The system also has appointment slot
scheduling, allowing patients to select preferred appointment type and appointment location,
together with preferred date and time slot. Nonetheless, there are inefficiencies found in this
system Firstly, the system does not have the feature to allow view of appointment status,
whereby staff need to contact the patient to reschedule appointment. Next the system requires
patients’ manual check in during the appointed date for the hospital administrator to check the
patients’ records.

With this web-based appointment system, patients are required to login to the WAS, and schedule
an appointment. After successful scheduling, patients will be given an appointment number.
During the designated time on the scheduled appointment date, patients will directly get the
registration that is allocated to their appointment number, thus removing the need to queue and
wait for the registration. This system will significantly decrease total waiting time of patients,
especially insignificant queue waiting time. One of the weaknesses of this system is lack of
reminder system. It is suggested that the additional use of reminder system should be considered
to reduce non-attendance rates of patients.

In addition, (Lekan & Abiodun, 2017)proposed a web-based appointment system to minimize

long patient waiting time and workload for hospital personnel.

The proposed system allows the patient to view appointment dates that are available and non-
available and ability to view the doctor’s scheduled calendar. Moreover, doctors or
administrators are able to edit the appointment slot in the system during any emergency situation.
The proposed system enables patient to view the status of the appointment, allowing them to
know the best time to book an appointment when there are no pending appointments. This will
reduce long waiting time and long queue for patients, while also having the freedom to fix and
book an appointment based on their own preference (Akinode et al, 2017).

BruHIMS (Brunei Health Information Management System) is an ICT initiative where the
management of patients’ personal information in all medical facilities are done through an
electronic patient record system and including appointment system and outpatient management
system. This system manages patients flow by scheduling appointments beforehand and
providing early preparations of healthcare locations which will significantly decrease the
wastage of time slots owing to non-availability of either doctors or patients. This is because it
validates the available and non-available slots for both parties. However, one of the drawbacks of
this system is scheduled patients are required to present their appointment cards to be scanned
before appointment to alert the system. Next, the system sets priority level of scheduled patients
based on age and status of registration rather than the level of sickness.

Furthermore, another web application was proposed to minimize patient waiting time and
allowing simpler way to find specific doctors for diseases. (H et al., 2021)

2.3 COMPARATIVE STUDIES

Our modern age of technology is greatly dependent on internet. An online system is also known
as a Web-based system. As the world is going so faster so there is always a desire to
communicate faster and effectively. There are no such things that comes out without any
limitations but we focused to overcome the best we could do. Our main focus was to determine
the features for the patients. They are the large community of this system and they deserve to get
the most out of this system. By using this system both doctors and patients become beneficial.

A lot of patient’s daily visit to healthcare clinic or hospital and facing problem regarding have no
knowledge about doctor specialty, wait for a long time to get doctor appointment and patients
have no about doctor fee. There are several ways to booking an appointment. A person can either
go to the hospital directly for consultation or make an appointment from home through internet
by Web-based system. To solve this problem, we have developed an appointment system which
improve the patient’s satisfaction like patient can get reliable and timely access. So that we wish
to offer such a system which will help them a lot. Our system will provides best result and save
their valuable time too.(Islam et al., n.d.)
2.4 WAITING TIME: Waiting time simply means a period of time which one must wait in
order for a specific action to occur, after that action is requested or mandated Patients’ waiting
time has been defined as “the length of time from when the patient entered the outpatient clinic
to the time the patient actually received his or her prescription”. It is defined as the total time
from registration until consultation with a doctor. There were two waiting times, the first is time
taken to see a physician and the second is time to obtain medicine. This paper deals with the
waiting time to see physicians.

With the passage of time, long waiting lines at doctor’s clinics became a major problem in
developing countries. In a South African health clinic, block appointment system was introduced
as an experiment, in which waiting time for patients was measured for the period of one week
before and after the implementation of the appointment system. During the experiment,
interviews were taken from focus-group, staff, and patients and from results it was realized that
acute medically ill patients with prior appointments had short waiting times as compared to the
patients without appointments.(Maryam, 2018)

Appointments had no benefits for patients not seeing doctors or collecting repeat medication.
There was, however, an overall increase in patients' waiting times after introducing the system,
mainly due to one typical day in the follow-up study. Focus groups and interviews revealed that
staff were skeptical at baseline but at follow-up were positive about the system. Patients were
enthusiastic about the appointment system at all stages. The study shows that block appointments
can reduce patients’ waiting times for acute patients, but may not be suitable for all patients.
Staff and patients had different views, which converged with experience of the new system.
(Ospitals, 2014)

2.4.1 PATIENTS’ APPOINTMENT SYSTEM: A patient appointment system or appointment

schedule for health care center started long time ago. Management of patients’ appointments has
earlier worked 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. 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. 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.

2.4.2 APPOINTMENT DELAY: Past research shows that the longer the appointment delay
which is defined as the time between the day a patient requests an appointment and her actual
appointment date, the higher the chances that he/she will cancel or not show up. This suggests an
obvious way of minimizing no-shows and cancellations: this is done by asking the patients to
come right away or make appointment requests on the day they want to be seen. This is called an
open access (OA) or advanced access policy, and of late it has become a popular paradigm in
practice and the subject of active research. Several authors report on their experiences in
implementing OA, both positive and negative. Some practitioners strongly advocate OA, and
there are some who are strongly against it.(Qaffas & Barker, 2015)

2.4.3 MANAGING PATIENTS’ APPOINTMENT SYSTEM: According to(Dexter, 2016),

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 patients’ waiting time than the health care center
that adopts the patients’ 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 center, they can evaluate the quality of service in the center (Dexter, 2016). Hence,
developing patients’ appointment process for health care centers necessitates the use of a
sophisticated queuing model that captures much of the real system’s 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.
REFERENCES

Dexter. (2016). HEALTH CARE ONLINE DOCTOR APPOINTMENT ( Android application ).

H, K., V, S., M, P., K M, M. F., & K, S. (2021). Doctor Appointment System Using Cloud.
International Research Journal on Advanced Science Hub, 3(Special Issue ICARD 3S), 13–
17. https://doi.org/10.47392/irjash.2021.053

Islam, A., Mia, R., & Hossain, S. (n.d.). Doctor appointment system: medicate. May 2019.

Lee, S., Min, D., Ryu, J. H., & Yih, Y. (2013). A simulation study of appointment scheduling in
outpatient clinics: Open access and overbooking. Simulation, 89(12), 1459–1473.
https://doi.org/10.1177/0037549713505332

Lekan, A. J., & Abiodun, O. S. (2017). Design and Implementation of a Patient Appointment and
Scheduling System. International Advanced Research Journal in Science, Engineering and
Technology ISO, 4(12), 16–23. https://doi.org/10.17148/IARJSET.2017.41203

Maryam, T. (2018). ONLINE POLYCLINIC APPOINTMENT AND DATABASE. August.

Ospitals, T. E. H. (2014). D EPENDABLE O NLINE A PPOINTMENT B OOKING S YSTEM F

OR N HIS O UTPATIENT I N N IGERIAN. 6(4), 59–73.
https://doi.org/10.5121/ijcsit.2014.6405

Qaffas, A., & Barker, T. (2015). Online Appointment Management System. March.

Robinson, L. W., & Chen, R. R. (2010). A comparison of traditional and open-access policies for
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