online appointment scheduling system thesis philippines

A Web-Based “InstaSked” Appointment Scheduling System at Perpetual Help Medical Center Outpatient Department

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• Sheily Mendoza 7 , 8 ,
• Ranzel Cloie Padpad 7 , 8 ,
• Amira Jane Vael 7 , 8 ,
• Cindy Alcazar 7 , 8 &
• Rolando Pula 9 , 10  

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Patient’s satisfaction and comfort are the priorities of every hospital. With the traditional appointment system, patients have been experiencing long waiting time, which causes dissatisfaction. This study designed a new web-based appointment scheduling system the “InstaSked” which could reduce the waiting time experienced by patients. It is designed for patients (booking their appointment), medical secretaries (managing patient list), doctors, and management (monitoring patients). The system used an integration of the Six Sigma methodology, DMADV (define, measure, analyze, design, and verify), and BPM (business process management).

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Acknowledgments

The authors would like to thank all those who help in the completion of the project, especially UPHMC for allowing the study to be conducted in their vicinity. Special mention to the hospital staffs in supporting the study, providing all the necessary help the researcher needs.

Recommendations The researchers would like to recommend that a hospital management system should be applied. This would greatly help the doctors and secretaries in tracking their patients’ record. A database that includes patient’s records, results, consultations, and the like is highly recommended.

Creation of a mobile application version of InstaSked is also recommended, because it would be easier for the patients.

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Industrial Engineering Department, University of Perpetual Help System DALTA, Las Piñas City, Philippines

Sheily Mendoza, Ranzel Cloie Padpad, Amira Jane Vael & Cindy Alcazar

University of Perpetual Help System DALTA, Las Piñas City, Philippines

Graduate Studies, Mapua University, Manila, Philippines

Rolando Pula

School of Graduate Studies, Mapua University, Manila, Philippines

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Correspondence to Sheily Mendoza .

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University of Perpetual Help System DALTA, Las Pinas, Philippines

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Cheongju University, Chungchongbukdo, Cheongju-si, Korea (Republic of)

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Bataan Peninsula State University, Balanga, Philippines

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Mendoza, S., Padpad, R.C., Vael, A.J., Alcazar, C., Pula, R. (2020). A Web-Based “InstaSked” Appointment Scheduling System at Perpetual Help Medical Center Outpatient Department. In: Beltran Jr., A., Lontoc, Z., Conde, B., Serfa Juan, R., Dizon, J. (eds) World Congress on Engineering and Technology; Innovation and its Sustainability 2018. WCETIS 2018. EAI/Springer Innovations in Communication and Computing. Springer, Cham. https://doi.org/10.1007/978-3-030-20904-9_1

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Published on 26.4.2017 in Vol 19 , No 4 (2017) : April

Web-Based Medical Appointment Systems: A Systematic Review

Authors of this article:

Original Paper

• Peng Zhao 1 , MSc   ; 
• Illhoi Yoo 1, 2 , PhD   ; 
• Jaie Lavoie 3 , PharmD, MS   ; 
• Beau James Lavoie 4 , PharmD, MS   ; 
• Eduardo Simoes 1, 2 , MSc, DLSHTM, MPH, MD  

1 Informatics Institute, University of Missouri, Columbia, MO, United States

2 Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, MO, United States

3 Vizient, Center for Advanced Analytics & Informatics, Chicago, IL, United States

4 Trinity Health, Livonia, MI, United States

Corresponding Author:

Illhoi Yoo, PhD

Department of Health Management and Informatics

School of Medicine

University of Missouri

Clinical Support and Education Building (DC006.00)

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Columbia, MO, 65212

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Phone: 1 5738827642

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Background: Health care is changing with a new emphasis on patient-centeredness. Fundamental to this transformation is the increasing recognition of patients' role in health care delivery and design. Medical appointment scheduling, as the starting point of most non-urgent health care services, is undergoing major developments to support active involvement of patients. By using the Internet as a medium, patients are given more freedom in decision making about their preferences for the appointments and have improved access.

Objective: The purpose of this study was to identify the benefits and barriers to implement Web-based medical scheduling discussed in the literature as well as the unmet needs under the current health care environment.

Methods: In February 2017, MEDLINE was searched through PubMed to identify articles relating to the impacts of Web-based appointment scheduling.

Results: A total of 36 articles discussing 21 Web-based appointment systems were selected for this review. Most of the practices have positive changes in some metrics after adopting Web-based scheduling, such as reduced no-show rate, decreased staff labor, decreased waiting time, and improved satisfaction, and so on. Cost, flexibility, safety, and integrity are major reasons discouraging providers from switching to Web-based scheduling. Patients’ reluctance to adopt Web-based appointment scheduling is mainly influenced by their past experiences using computers and the Internet as well as their communication preferences.

Conclusions: Overall, the literature suggests a growing trend for the adoption of Web-based appointment systems. The findings of this review suggest that there are benefits to a variety of patient outcomes from Web-based scheduling interventions with the need for further studies.

Introduction

Background of web-based appointment system.

Traditionally, medical appointments have been made with schedulers over the telephone or in person. These methods are based on verbal communications with real people and allow for maximum flexibility in complicated situations [ 1 ]. However, because these traditional methods require the intervention of schedulers, the ability to get a timely appointment is not only limited by the availability of appointment slots, but also by the schedulers and phone lines [ 2 , 3 ]. Patients’ satisfaction with appointment booking is influenced by their ability to book at the right time with the right health service providers [ 4 ].

The Internet has recently emerged as another means to make appointments. Web-based appointment scheduling has been a popular research topic. Several studies conducted satisfaction surveys and found that Web-based appointment scheduling is an extremely important feature, and most patients would use the service again [ 2 , 5 - 7 ].

There are two major types of Web-based medical appointment services, medical scheduling software as a service (SaaS) and proprietary Web-based scheduling systems. Medical scheduling SaaS has gained increasing prominence in recent years. These appointment systems are not built up by health care practices themselves, but are provided and maintained by health IT companies such as ZocDoc and InQuicker on a paid subscription basis [ 8 ]. The appointment services are cloud-based and can be integrated into health care providers’ own management systems. The other type of appointment service is proprietary appointment systems, which are integrated into patient portals on providers’ websites [ 9 ]. A patient portal is a secured Web-based service that allows patients to access their health information and communicate with their health care providers at any time [ 10 ]. In the United States, the growth of patient portals has largely been spurred by meaningful use (MU) requirements [ 11 ] because of the federal incentive program for adoption of electronic health records. To meet the requirements of MU and receive its incentives, the portal should be actively used by both the practice and patients [ 12 ].

There are two modes of Web-based appointment systems, asynchronous and real-time. In the asynchronous mode, appointments are requested through emails or electronic forms on providers’ website, and then manually processed by schedulers. In the real-time mode, patients can directly interact with providers’ scheduling management systems [ 3 , 13 ]. Although the asynchronous Web-based appointment systems also use the Internet as a medium, they basically replicate the process of telephone-based appointment scheduling [ 13 ]. Under the asynchronous mode, if an appointment is requested outside of a provider’s business hours, it will not be processed until schedulers return to work. Normally, Web-based appointment requests are put in the same queue as phone-call appointments, and are thus limited by the backlog of phone calls in the queue [ 14 ].

Aims of the Study

Despite the increasing adoption of Web-based appointment systems, their potential benefits are yet to be systematically studied. The purpose of this review was to examine the current body of literature about Web-based medical appointment systems, specifically in regard to their potential benefits to patients and providers. We also want to identify the most effective services or components of them and explore the benefits and barriers of implementation. It is not the intention of this work to review the literature regarding fundamental theories of medical scheduling or system design, which have been studied and reviewed by Cayirli et al [ 15 ] and Gupta et al [ 16 ]. To the best of our knowledge, this study is the first systematic literature review of the impacts of implementing Web-based medical scheduling systems.

Data Source

In this study, we present a systematic literature review of Web-based medical appointment systems following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews [ 17 ].

A literature search was performed in MEDLINE using PubMed to identify pertinent articles relating to the impacts of Web-based appointment scheduling. The MeSH terms used in the search included “Internet,” “computers,” “cell phones,” “electronic mail,” and “appointments and schedules.” “Smartphone” used to be an entry term for “cell phones,” and it became a MeSH Descriptor in 2016. To include articles indexed by “smartphone” after 2016 and articles involving smartphones before 2016, “smartphone” was included in the search without any restrictions. Figure 1 shows the logical relationships among the search keywords and their restrictions in the search builder of PubMed.

The literature search was initially performed in April 2016. Since then, in order to make this literature review up-to-date (by including new articles), we regularly conducted literature searches with the same search keywords. Our last literature search was carried out in late February 2017.

Inclusion and Exclusion Criteria

In this study, articles published only after January 1, 1990, were included, because articles published earlier than this time were unlikely to be relevant to Web-based appointments. We only included articles mainly discussing general Web-based medical appointment services or a specific automated or Web-based tool that assisted patients in choosing a provider or making a medical appointment. The exclusion criteria were systems that solely discussed email- or phone-based appointment reminders and systems not designed for use by patients. Articles not written in English were excluded too.

Study Selection

The process of identifying eligible articles is shown in Figure 2 . The initial query returned 587 articles, which were then filtered by publication date and language. 145 articles were excluded because they were published before January 1, 1990. Also, 16 non-English articles were filtered out. The remaining 426 articles were reviewed based on titles and abstracts and 336 of them were excluded due to low relevancy. The remaining 90 articles were then reviewed in full text, and 54 of them were excluded as they do not mainly discuss Web-based medical appointment services or a specific automatic or Web-based tool helping patients to choose a provider or make a medical appointment. The remaining 36 highly relevant articles discussing 21 Web-based medical scheduling systems were used in this literature review.

Literature on this topic is very recent, with 16/36 articles published after 2010 and 35/36 published after 2000. The studies are highly heterogeneous in research design. More than one third (14/36) of the articles [ 3 , 13 , 18 - 29 ] discuss Web-based scheduling as standalone systems or components of portals, and report measurable or perceived (unquantified) improvements in some metrics after the implementation. Eight studies [ 1 , 2 , 5 , 7 , 30 - 33 ] conducted structured or semistructured interviews to sample patients’ attitudes toward specific Web-based appointment systems, and one study [ 34 ] surveyed both patients and providers regarding the transformation to patient-centered access to care. Six articles [ 9 , 35 - 39 ] discuss the necessity and the potential of computerized or Web-based appointment services. Three studies [ 8 , 14 , 40 ] retrospectively analyzed Web-based appointment data and compared them with traditional appointments. Two studies [ 6 , 41 ] surveyed people’s interest in using the Internet to schedule appointments (not tied to any specific Web-based appointment systems). One study [ 42 ] used a randomized controlled trial to assess the impact of a Web-based health management system. Another study [ 43 ] reported a Web-based provider recommendation system and validated it with a field experiment. These articles also vary in interventions and the granularity of information provided. Many studies were implemented in only a single clinic and had interventions that spanned from basic websites to detailed patient portals. Details provided about the specific components of each system and functionality vary from study to study and many offer only a vague description. Many studies also used multiple interventions simultaneously, such as a Web-based scheduling system with automated reminders and patient decision tools and patient portals. As a result, these studies cannot be directly compared.

Multimedia Appendix 1 summarizes the characteristics of the 21 Web-based appointment systems discussed in the literature. Of these 21 Web-based scheduling systems, 1 is based in Australia, 1 in Canada, 1 in mainland China, 1 in Taiwan, 2 in the United Kingdom, and the remaining 15 in the United States.

Many articles specifically measured reductions in no-show rate and waiting time as metrics to evaluate Web-based scheduling services.

Siddiqui et al [ 8 ] reported a no-show rate of 6.9% for dermatology appointments made with ZocDoc, significantly lower than the no-show rates of appointments made by traditional appointment making means (17-31%). The UK national online electronic referral and booking service “Choose and Book” was reported to have a significantly better rate of attendance than traditional appointment methods (95% CI 4.3, 20.5%, P <.01) [ 40 ]. Walters et al [ 25 ] reported the Web-based communication tool “Patient Online” reduced no-shows by 42%. The Dartmouth-Hitchcock Medical Center in New Hampshire has reduced no-shows by 40% after implementing an asynchronous clinical messaging service that allows patients to request, review, reschedule, and cancel appointments [ 26 ]. The US Department of Defense’s health care program Tricare achieved a no-show rate of 2% from Web-based scheduling compared with 8% from phone-based scheduling [ 20 ]. The Murry Hill Medical Group based in New York had a similar pattern in the no-show rate: less than 1% of Web-based appointments were missed compared with about 8% of phone-based appointments [ 21 ].

Cao et al [ 31 ] reported the Web-based appointment system (WAS) reduced the total average waiting time to 7 min from 98 min in a Chinese hospital because patients don’t need to queue up for the appointments when they use WAS. In the United Kingdom, the Department of Health requires the maximum waiting time for sexual health service appointments to be 48 h. The introduction of eTriage increased the percentage of patients offered an appointment within 48 h from 48% to 100% [ 2 ].

Besides reductions in no-show rate and waiting time, many other improvements were also reported from the literature and they are summarized in Figure 3 . The horizontal axis indicates the number of mentions of Web-based scheduling systems for each impact after implementing the 21 Web-based scheduling systems. To limit the number of categories (on the vertical axis), some of the close metrics were merged into a broader category. For example, “optimizing the referral process” and “streamlining operations” were merged into “improving efficiency,” as they both indicate improvements in the internal operations of the practices. Figure 3 shows that the most cited (10/21) positive change is “reducing staff labor,” closely followed by “improving satisfaction” (7/21), “improving efficiency” (6/21), “reducing no-show” (6/21), “reducing wait time” (6/21), “increasing revenue” (4/21), “increasing popularity” (4/21), “reducing cost” (3/21), “balancing patient load” (1/21), and “reducing wrong appointment type” (1/21).

Principal Findings

The Web-based medical appointment reframes the way to communicate with providers’ appointment management systems. Compared with traditional appointment methods, Web-based appointment scheduling has unique advantages and disadvantages. In this section, the key benefits and barriers to the adoption of Web-based appointment scheduling will be discussed.

Patient-Centeredness

Patient-centeredness is one of the six quality aims proposed by the Institute of Medicine to improve health care quality in the United States [ 34 ]. Web-based medical scheduling as a medical self-service offers a more patient-centered means to make appointments [ 6 ]. Most Web-based appointment systems are interfaced with a calendar-like list. Patients can browse and select the most convenient appointment time from the available time slots [ 21 ]. In contrast, patients are only given very limited options of available time slots in traditional appointment systems. Besides time slots, some of the Web-based systems allow patients to filter physicians by physicians’ attributes such as education background, experience, gender, and reviews from other patients [ 8 ].

Another convenience from improved patient access is that patients can fill out registration forms [ 26 ], get prescreened and review practice policies online [ 23 ] before they show up and this can smooth workflow and reduce misunderstandings.

In the self-servicing Web-based appointments, patients’ own descriptions of the reason for visit are often more detailed and illuminating [ 13 ]. Sometimes, patients might be uncomfortable or unable to vocalize certain symptoms (eg, sexual health problems) to the scheduler over the phone or in person, and they may make an untrue statement [ 2 , 13 ]. They tend to be more candid when they schedule online by themselves [ 13 , 20 ].

Reduced No-Show Rates

No-show is a significant cause of wasted clinical resources [ 40 ]. The patient-centered design in Web-based appointments has the potential to decrease no-show rates [ 8 , 25 ]. The reasons for the reduction of no-shows after implementing Web-based scheduling have not been systematically studied in the literature, but it could be attributed to the improved access in Web-based scheduling that allows patients to easily verify, cancel, and reschedule their appointments [ 25 ]. A possible reason is that patients feel more responsible for their appointments when they make appointments by themselves [ 44 ].

Reduced Waiting Time

Waiting is an indicator of service quality and a source of dissatisfaction that affects health care outcomes and patient retention [ 45 , 46 ]. Long waiting time may make patients seek care from other providers and thus this can potentially cause a loss in revenue.

The most cited benefit of real-time scheduling is after-hour access [ 1 , 3 , 21 ]. Real-time scheduling requires minimal intervention of schedulers and thus can help reduce the waiting time caused by human factors. The available time slots are transparent to patients through the Web interface. Patients are free to claim available appointment slots anytime and anywhere [ 3 , 20 , 37 ].

The support of same-day or soon appointments by some real-time systems can help further shorten the time between when the appointment is requested and when the medical service is fulfilled [ 3 ]. Although there is a concern that the ability to book in advance for chronic conditions might be diminished by same-day appointments due to the limited number of appointment slots [ 47 ], same-day appointments could produce positive outcomes as long as the provider can find a balance in his or her capacity. For providers, it is possible to reuse the time slots released due to late cancellations. These allotted time slots will be otherwise wasted if traditional appointment methods are used because of the longer turnaround time [ 8 ].

Barriers to Adoption

It is well known that medicine has lagged in the adoption of new technologies. Although Web-based appointment scheduling comes with many benefits, some providers and patients are reluctant to use it. By 2007, only about 3.2% of the population in 7 European countries (Denmark, Germany, Greece, Latvia, Norway, Poland, and Portugal) had used the Internet to make medical appointments [ 41 ]. Only about 15% of public hospitals and 18% of private hospitals in Italy allowed appointments to be made online in 2008-2009 [ 39 ]. According to a study conducted by Google and Compete (a research vendor) in 2012, only 21% of patients booked appointments via computer or mobile devices [ 48 ]. Only about 7% of primary care practices in Canada and 30% in the United States offered Web-based appointment services in 2012 [ 49 ]. As of 2014, 67% of general practitioner (GP) practices in Scotland have websites and only 10% of them support Web-based appointments [ 35 ].

There are many reasons for the slow adoption. First, the transition requires the practices to give up legacy systems they have relied on and change the fundamental workflow and administration already established [ 3 , 13 , 28 , 37 ]. A large investment would be required for the providers to move toward new centralized Web-based scheduling systems [ 28 ].

Second, real-time Web-based scheduling lacks flexibility in the medical setting because the automatic appointment systems are not intelligent enough to handle cases not predefined. Unlike the appointment scheduling in other industries such as airline ticket booking, which has strict rules, medical appointments are tailored based on the knowledge of physicians and patients, and thus can be rather flexible [ 13 , 28 ]. Physicians have their own preferences in appointment patterns, whereas the booking preferences for different patients can be rather distinct and can change over time [ 4 ]. The “Mabel factor” depicts a situation in which a scheduler knows how to balance the practice’s available resources and human factors such as physicians’ preferences and patients’ needs [ 3 , 13 ]. It is challenging for real-time Web-based scheduling systems to achieve the same level of flexibility. In reality, physicians have to give up their preferred scheduling patterns to accommodate the simplified real-time scheduling rules [ 3 , 13 ].

Third, safety is a concern. It is challenging to triage patients who made appointments through real-time Web-based appointment systems. Patients may misuse Web-based appointment systems for urgent conditions that need to be handled immediately by an emergency room or urgent care [ 13 , 20 ]. Because schedulers are no longer involved in the appointment process, the systems should be capable of triaging patients and stratifying their risks accurately. Some practices just display static warning messages on their Web presence to stop patients from using their appointment systems for urgent conditions [ 13 ]. Some real-time systems still rely on human reviewers to screen for possible emergencies [ 3 ]. Very few real-time appointment systems reported in the literature can automatically identify emergency conditions [ 2 ].

Finally, many providers have a fear of losing control of their appointment systems, as they think patients may abuse the systems [ 20 , 23 , 44 ]. For example, patients may book appointment slots and end up with no-shows or late cancellations. As a result, valuable clinical time would be wasted. However, this issue can be addressed by enforcing predefined appointment rules, such as rules for cancellation and a penalty for no-shows [ 37 ]. Providers can also block out appointment slots and limit visit types to accommodate their schedules [ 20 ]. Blocking patients with no-show history and collecting copay up front when making an appointment can discourage no-shows [ 37 ]. Automatically generated email- or message-based reminders can also help reduce no-shows [ 37 ]. Some practices refuse to expose physicians’ open time slots, because they believe that patients might think the physicians do not work hard enough when they see many openings [ 21 ].

In addition to the four main barriers, studies found that the following common problems from the patient side considerably affect the adoption of Web-based scheduling: unawareness of the Web-based appointment service, low penetration and distrust of the Internet, low computer skills, and the preference for verbal communications [ 1 , 8 , 30 , 31 ].

Limitations

This review has a few limitations. First, the collection of literature has a long time span ranging from 1990 to 2016. With the rapid development of information technology, many systems, especially those implemented in 1990s and early 2000s, experienced significant changes after they were introduced and reported. Some of the original services have been discontinued and replaced with other services [ 24 ], whereas some practices have switched software service vendors [ 28 ].

Second, many studies lack statistical research designs and have used multiple interventions at once. Although there are many improved metrics reported in the literature, it is difficult to determine whether these improvements are solely resulted from the implementation of the Web-based appointment systems. In addition, as many reported Web-based appointment services are components of health care Web services or patient portals, it is possible that the positive changes could be attributed to other components of the system.

Third, several studies have discrepant and even contradicting results. This is because the studies are from various sources with differences in care type, patient population, study period, and study design. Therefore, it is hard to compare their results systematically.

Fourth, many studies failed to report the information about assessment methods used in their studies, making it hard to judge their findings.

Finally, this work only reviews Web-based scheduling systems reported in the academic literature and does not reflect all systems available in the market.

Conclusions

In this study, we sought evidence from the literature to discuss the benefits and challenges of implementing Web-based medical appointment systems. Compared with traditional appointment methods, Web-based appointment scheduling is more patient-centered and has many advantages due to improved access. After implementing Web-based appointment systems, many practices have shown positive changes such as reduced no-show rate, decreased staff labor, decreased waiting time, and improved patient satisfaction.

Although these changes suggest Web-based appointment systems could produce positive outcomes, this assertion should be further reinforced by more sophisticated study designs. As in some studies, the Web-based appointment services are components of portals and it is hard to measure their impacts statistically. Some studies reported results without controlling for other factors. It is possible that the positive outcomes are produced by the other factors or by the combination of the Web-based appointment systems and the other factors.

Providers and patients both have reasons for the slow adoption of Web-based appointment scheduling. Cost, flexibility, safety, and integrity are major reasons discouraging providers from using Web-based scheduling. Patients’ reluctance to adopt Web-based appointment scheduling is mainly influenced by their past experiences using computers and the Internet, as well as their communication preferences.

Overall, the literature suggests a growing trend for the adoption of Web-based appointment systems. The findings of this review suggest that there are benefits to a variety of patient outcomes from Web-based scheduling interventions with the need for further studies.

Conflicts of Interest

None declared.

Multimedia Appendix 1

Summary of the 21 Web-based scheduling systems.

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Abbreviations

Edited by G Eysenbach; submitted 07.10.16; peer-reviewed by D Miller, P Yu, X Zhang; comments to author 17.11.16; revised version received 31.12.16; accepted 04.03.17; published 26.04.17

©Peng Zhao, Illhoi Yoo, Jaie Lavoie, Beau James Lavoie, Eduardo Simoes. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.04.2017.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

A Web-Based Medical Appointment Scheduling with SMS Alert Notification System

• Bassey Ele University of Calabar
• Odey, J. A. Department of Computer Science University of Calabar, Calabar Cross River State - Nigeria
• Frank, N. E. Department of Computer Science Akwa Ibom State College of Science and Technology, Ikono Akwa Ibom State - Nigeria
• Ekinya, I. M. Department of Computer Science University of Calabar, Calabar Cross River State - Nigeria

Lengthy waiting times for registering and booking an appointment to see a doctor is challenging in Nigeria, particularly in government hospitals. Also, missed healthcare appointments are the main cause of preventable incompetence that affects a patient’s wellbeing and medication results, as there is no machinery to notice patients when appointments are deferred or canceled. To address these issues, a web-based medical appointment scheduling system with SMS alert notification using the University of Calabar Teaching Hospital (UCTH) as a case study is proposed.  This study adopted the Structured System Analysis and Design Methodology in the development of the system. MySQL was used to design the database for this study and the proposed system was implemented using PHP programming language. A web-based medical appointment scheduling with an SMS alert notification system was developed and implemented in this study. The developed system will improve appointment scheduling in hospitals to simplify patients' and doctors’ tasks and eliminate missed appointments with the help of the reminder component. In the upcoming, the system can be developed to direct appointment applications to another hospital where doctors with similar medical proficiency are working. Furthermore, the provision of automated SMS alerts as notifications as the appointed day draws near or reaches is a fundamental characteristic of the developed system.

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The online appointment system at the university health centre was intro-duced by the University of Technology (UTech), Jamaica management in 2014. The purpose of this study was to determine the users’ views of the online appointment system, as well as their views about the services offered at the university health centre. To achieve this purpose, a descriptive research design was used to answer three research questions. The con-venience sampling method was used to select 50 participants (30 students & 20 university staff members), who visited and used the health centre services. A questionnaire with an internal consistency of 0.87 was used to collect data from the participants who gave their consent. The findings showed that a majority of those who used the online appointment system were satisfied. The general view of the users about the health services provided at the health centre was positive. The results of the Fisher Exact test showed that there were differences in the views of the students and the staff in their responses to two items that measured the services provided by the doctors, and the access to the different services. Recommendations were made on how to improve the online appointment system as it relates to timing, and quality of services provided.

Online Appointment System , Health Services , University Health Centre

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1. Introduction

Outpatient health care centers have been around in different settings for several years. One of these settings is within the campus of institutions of higher learning. In some institutions, the health care centre is designed to provide general outpatient care and programmes such as health education and counselling for staff and students. At times, some of the users demand better operational management due to lack of quality service. This has led to empirical studies being done to address patients’ complaints on waiting time, online appointment (scheduling) system, expectations, and improving the quality of services offered; others focus mainly on patient satisfaction. The term appointment was defined by Mardiah and Basri [1] as “the period of time allocated in the schedule to a particular patient’s visit” (p. 29).

A number of studies have been done on scheduling (e.g. [2] [3] ), just to name a few. Daily scheduling has been said to improve the “capacity utilisation by letting providers to fit appointment of varying length in a daily schedule, by which providers can take care of deviations from planned clinic time and scheduled appointments” [2] (p. 72). It is stated that the “overall goal of a well-designed appointment system is to achieve a balance among the competing and conflicting goals of minimizing the patient time and the doctor’s idle time and overtime” [3] (p. 682). A well-designed scheduling system would contain “three types of decisions: appointment rule, patient classification, and adjust for no-show and walk-in” [2] (pp. 72-73). This allows for good quality care. Quality care is seen as the “central dimensions of public health” [4] (p. 61). Furthermore it is stated that “Good quality care needs to be delivered at the earliest and at the proper time which is [the] basic right of consumers” [4] (p. 61).

The online appointment system is “a win-win solution for patients and physicians…” [5] (p. 6). This view was also expressed by others [6] . This may be one of the reasons why there are several studies about the online or web-based appointment system. For instance, in a retrospective study of a web-based appointment system (WAS) and the queuing method in China, the authors concluded that the patients using the WAS had a higher level of satisfaction with registration when compared to those who use the queuing method who experienced a longer waiting time [7] . These authors also stated that approximately 53% of the participants did not use the online appointment service because they were unaware of its existence. For this reason, they recommended the need to better promote the use of the WAS among the patients [7] . Another study in a hospital in Norway, how the standards inscribed in an electronic booking project works was examined by combining two social theories (actor-network theory, & the theory of collective action) [8] . The authors concluded that in certain conditions such as when the patients’ problems are unclear, the use of traditional and the electronic systems booking would be better [8] .

In a different study in India, the authors concluded that although the appointment system has several benefits, it is also affected by several factors such as the “arrival and service time variability, patient and provider preferences, available information technology, and the experience level of the scheduling staff” [9] (p. 21). However, the online scheduling, they stated, has more advantages when compared to the traditional appointment system. According to these authors, in the traditional appointment system, the scheduling is done by coming into the facility and the waiting time tends to be reasonably long [9] . The waiting time is minimised with the online appointment system. They also stated that the online scheduling system provides the following benefits, namely,

• Schedule patients for various medical procedures-test, treatment,

• View daily, weekly, monthly patient schedule,

• Create patient records and appointment reports,

• Helps to track patient flow based on arrival, visit and departure time,

• Avoid no-show missing, over-booking patients and other conflicts,

• Email appointment schedule reminder,

• Provide daily appointment scheduling reports. [9] (p. 26).

A similar set of benefits were also identified by [10] who also described six different types of appointment scheduling (double booking, like visits together, ten minutes increments, modified wave scheduling, staggered starts, & group meetings) used in hospitals. For details, see [10] .

In another study, [5] examined the online booking system in hospitals in Iran. Their study showed that 52.8% of the hospitals still used the in-person appointment method, while 47.2% used the remote methods (SMS, call, internet, call-SMS, & call internet), with only 13.0% of the hospitals using the online appointment method. Samadbeik et al., [5] concluded that the traditional (in-person) method was mostly used despite the waiting time disadvantage. Using a mixed methods approach, Pare, Trudel, and Forget [6] examined the impact of e-booking in private medical practices in Canada over a two-year period. Their findings showed that there is an increased interest in the use of this system in Canada. Their findings also revealed that the users were appreciative of the system due to its benefits (flexibility in scheduling, time-saving, & automated reminders). With all the growing popularity, many persons are still not using the online scheduling system. The results of a study done in China by Zhang, Zhang, Sun, Cai, Yang, and Zhang [11] revealed that only 17% of the patients surveyed used the web-based system, and most patients used the queuing method.

Apart from scheduling, the literature shows that patient satisfaction by measuring quality care has gained a lot of attention as scholars try to identify gaps that can be addressed in order to improve health care services. Patient satisfaction means “the extent to which general health care needs of the clients are met to their requirements” [4] (p. 59). Among the studies on patient satisfaction, Sadjadian, Kaviani, Yunesian, and Montazeri [12] conducted a study involving 425 women in a breast cancer care clinic in Iran. Their study showed that 82% of these women were either satisfied or very satisfied with the clinic’s overall performance. In a study conducted in India with 200 patients, Panda, Sinha, and Soni [13] reported that 56% of the participants were satisfied with the services at an out-patient department. Other scholars including [4] [14] [15] conducted similar studies in different countries. In a study in India with 400 patients, [15] found out that a majority of the patients were satisfied with the facilities available as well as the attitude of the doctors and other health staff of the hospital. On the contrary, a study done in Jordanian hospitals, Al-Refaie [16] revealed that service quality (admissions, registration, waiting time, and response time to results of medical tests) was the area that the patients were unsatisfied with. A big part of the quality of service and patient satisfaction is the consultation time between doctors and patients. The duration of consultation time varies from one country to the other due to patient’s and doctor’s characteristics [17] . In a study done in Malaysia, Ahmad, Hhairatul, and Farnaza found that the average consultation time for their study was 18.21 minutes [17] . In the health centre used for this study, the consultation time based on the online scheduling system is 15 minutes.

The review of the literature also showed others studies done on health issues and service utilization of university students [18] ; health problems with college students [19] ; issues in university health services [20] ; and the use of medicine by university students in Mozambique [21] . Other studies include Wise [22] which examined patient utilisation of student health services at the University of North Carolina. This study focused on the factors that influenced students’ attitudes towards the services provided at the student health centre [22] . El-Gilany, El-Masry and Badwy investigated students’ utilisation of health services at the Mansoura University in Egypt [23] . The main focus was on patterns of morbidity and drug prescription among patients. Regarding the integration of health centre and pharmacy services, [24] and [25] are some of the scholars who have written on this topic. In a commentary by Inguanti [24] , it was noted that pharmacy services located in health centres play an important role in providing services within the same location since they offer a one-stop service at a reduced cost to the patients. Such health centres, are noted “focus on meeting the basic health care needs of their individual communities” [24] (p. 151). On the other hand, Wright, Gorman, Odorzynski, Peterson et al. investigated the potential benefits of having a pharmacy within mental health centres in Michigan, in the United States [25] . Their findings showed that patients using pharmacies located within the proximity to the source of prescription had better adherence to medication, and also found it to be cheaper.

The review of the literature clearly shows the need for more studies on health care units within higher education institutions to be studied in the Caribbean. This paper is designed to fill this gap in the existing literature. In this study online appointment system and online scheduling system are used interchangeable.

1.1. Statement of the Problem

The practice before the online scheduling system was established was that the users of the health centre walked-in to schedule appointments before they could access the health care services. Furthermore, the old system was based on first come first served, which resulted in users lining up very early to write their names, and the arrival time in the registration book at the reception area or desk. The quality of service as it relates to the speed of registration and patient flow was slow and patients also experienced the long waiting time before seeing the doctor. Aware of the challenges of manual registration method, the university’s management introduced an online system for scheduling appointments in 2014. With this system, patients can select the date and time they would like to see the doctor, as well as select other services provided at the health centre, and the health centre staff can access the medical records ahead of the patient’s visit.

Since the launch of the online scheduling system for booking appointment, there has not been any study to document the users’ views on the system. This study was designed to provide evidence on the users’ views of the online scheduling system, its benefits and challenges. It is believed that the findings of this study will contribute to the existing body of literature on this topic as well as to lead to the improvement of the online scheduling system.

1.2. Research Questions

The following research questions were answered:

1) What are the views of the users about the online scheduling system?

2) To what extent are there differences in the views of the different groups of users (students vs staff & males vs females) about the services provided at the health centre?

3) What suggestions, if any, could be made on how to improve the online scheduling system and services at the health centre?

Only 50 users’ views on the online scheduling system and health services provided were investigated. Therefore, the findings cannot be generalised.

1.3. Description of Study Setting

The then College of Arts, Science and Technology (CAST), now the University of Technology (UTech), Jamaica opened its first health centre in 1971. Initially, the Health Centre had a visiting doctor, a college nurse and a nurse manager [26] . As the university expanded, there was a need in 2001, to relocate the centre to a bigger space, in order to accommodate the growing demand for health services on campus. This expansion also included increasing the staff strength. Currently, the staff strength is nine medical doctors (i.e., 2 full-time & 7 part-time), seven nurses (4 full-time & 6 part-time), an administrator, and one claims clerk.

During each academic year over 2,000 students and staff members visited the health centre. Because the lifestyles of staff and students are considered to be important, the medical health centre offer services that promote health and wellness among staff and students through seminars, lab result review, medicals, wound care, family planning, counselling, etc. [26] .

2.1. Design and Sample

A descriptive research design was used for the study to assess the users’ views on an online appointment system and services provided at a university health centre in Jamaica during the 2016/17 academic year. The convenience sampling method was used to select the study participants (n = 50) who visited the university health centre during that academic year. Consequently, there was no need for power calculation of the sample size.

2.2. Data Collection

Data were collected through the use of a questionnaire. The questionnaire had three sections. Section A contained four demographic items, while Section B had six items on the online scheduling system and one open-ended question on how to improve the online scheduling system. Section C contained 13 Likert-type items on health services. These items had a four-point response format of strongly disagree to strongly agree.

2.3. Data Analysis

The Statistical Package for the Social Sciences (SPSS), version 21 was used to analyse the close-ended items, while the Excel program was used for the open-ended item. This program was used because it was easier to identify the individual responses before organizing them into categories. For the close-ended items, descriptive statistics (simple percentage & cross-tabulation) was used for research questions one and two due to the nature of the questions asked. However, the Fisher’s Exact Test (2 × 2 contingency table) was also used for research question two in order to ascertain if there was any statistical difference in the respondents’ views. This was done to avoid generating misleading results due to the small number of observations per cell [27] .

2.4. Reliability and Validity

The Cronbach’s alpha method was used in estimating the reliability of the 13 Likert-type items in Section C of the questionnaire. The obtained reliability coefficient was 0.87, which is considered to be highly reliable [28] [29] . Content validity was established by using three experts to review the questionnaire items. This is to ensure that the items were about the online scheduling system and the health services.

2.5. Ethical Issues

This study falls under the health service evaluation category. The National Research Ethics Service (NRES) states that studies that are categorised under service evaluation are “designed and conducted solely to define or judge current care” [30] . This study, therefore, did not require research ethics review. However, several ethical practices were observed. For instance, the participants were not forced to take part in the study. Only those who consented completed the questionnaire. Names, as well as identification of the participants, were not collected.

The results are presented under four themes, namely, comparing demographic characteristics, comparing users’ views on online scheduling system, comparing users views on online scheduling and health centre services, and improve the online scheduling system and services.

3.1. Comparing Demographic Characteristics

To have an insight about the respondents in this study, demographic information, including gender, age range and status was collected through the use of a questionnaire. The data were analysed using cross-tabulation ( Table 1 ). A total of 14 (28.0%) males and 36 (72.0%) females participated in the study. The findings showed that 30 (60.0%) of the respondents were between the ages of 21 - 30 years. Thirty (60.0%) of the respondents were students and 20 (40.0%) staff members who had visited the health centre during the period the study was conducted.

3.2. Comparing Users Views on Online Scheduling System

Research Question One: What are the views of the users about the online scheduling system?

Regarding research question one, the respondents were asked to indicate if they were visiting the health centre for the first time. Of the 50 respondents, four or eight percent were visiting for the first time, while 46 (92.0%) had made several visits to the centre, and had also used the online scheduling system to book appointments. The respondents were asked to indicate how they find out about the online scheduling system. Of the 46 respondents who used the health centre previously, 12 (9.1%) learnt of it through the university email, five (11.4%) through a colleague, another five (11.4%) through a friend, and 22 (50.0%) through the health centre staff. The 46 respondents commented on how satisfied they are with the use of the online scheduling system ( Table 2 ).

Table 1 . Demographic characteristics of participants.

Table 2 . Respondents’ rating of the adequacy of the online scheduling system.

No response (NR) = 4.

As shown in Table 2 , 30 (65.3%) of the respondents rated the online scheduling system between “Somewhat Satisfied” and “Satisfied.” When the data were also analysed by gender, the result was the same. Thirty-eight (82.6%) of those who were satisfied, also indicated that it was user-friendly.

3.3. Comparing Users Views on Online Scheduling and Health Centre Services

Research Question Two: To what extent are there differences in the views of the different groups of users (students vs staff & males vs females) about the staff and the services provided at the health centre?

Regarding research question two, 13 Likert-type items were used to obtain the respondents’ views on the staff and the health services. For each of the statements listed in Table 3 , respondents were given answer choices of “Strongly Agree,” “Agree,” “Disagree,” and “Strongly Disagree.” It should be noted that “Neither” response was not offered.

The findings in Table 3 showed that 46 (92.0%) of the students and the staff agreed that the health center offers a sufficient variety of services; 47 (94.0%) had the same opinion that the services met their health needs; 37 (%) concurred that the services offered were always available; 49 (98.0%) were satisfied with the services provided by the nurses; 45 (90.0%) were satisfied with the level of care displayed by the nurses, and 49 (98.0%) of the students and the staff were satisfied with the level of care displayed by the doctors; and 40 (80.0%) also were satisfied with the services provided by the doctors; 41 (82.0%) were in agreement that the waiting time was reasonable; 42 (84.0%) were comfortable with the level of privacy and confidentiality; 43 (86.0%) agreed that with the online scheduling they had enough time with the doctor; 32 (64.0%) were also in agreement that they were clear about the procedure to be followed when accessing the different services offered at the health centre; 39 (78.0%) agreed that with the online scheduling, there is an improved customer service; and 42 (84.0%) were satisfied with the overall customer service.

To compare the samples on agreement, the four-point responses were recoded into two categories (“Agree” & “Disagree”). See Table 3 for the results of the Fisher Exact test. As shown in Table 3 , the students and staff displayed differences in their responses to two items, “I am satisfied with the services provided

Table 3 . Comparing users views on online scheduling and health centre services.

*P < 0.05.

by the doctors” (p = 0.01), and “I am clear about the procedure to access the different services” (p = 0.02). The association between the two samples is considered to be statistically significant. However, no significant differences were found in the other 11 items between the two groups.

3.4. Improve the Online Scheduling System and Services

Research Question Three: What suggestions, if any, could be made on how to improve the online scheduling system and services at the health centre? Four themes (appointment efficiency, walk-in and online scheduling system, linking health centre service with pharmacy, time management, & educating the users) emerged from the analysis of the responses to the open-ended question on suggestions on how to improve online scheduling system and services. The findings are presented under the themes mentioned above.

3.4.1. Appointment Efficiency

Several views were expressed about the efficiency of booking of appointment as some of the respondents expected that with the online scheduling system, their appointment with the doctor would be on time. However, their experiences reflected otherwise. Here are some of the suggestions made by the respondents:

• Using the online scheduling system, I was of the view that I will be seeing the doctor on time, but this is not the case. This system only allows you to indicate that you will be seeing a doctor. The doctors need to ensure that the patients get service on time. (Female student, 21 - 30 years)

• The doctors sometimes arrive late or are behind time in seeing the patients. The nurses and doctors should consult within the time frame booked by the patients. (Male, staff, 41 - 50 years)

3.4.2. Walk-in and Online Scheduling System

Some of the respondents were not of the view that both the online scheduling system and the walk-in method should be used in the health centre. This omission of information was reflected in their suggestions. It should be pointed out that both the online scheduling system and the walk-in method are used. However, the latter is usually done to accommodate emergency cases. Here are some of the comments made by the respondents:

• I need to be able to see a doctor through the walk-in method. (Female staff, 41 - 50 years)

• It will be nice to accept walk-in patients also. (Female staff, 31 - 40 years)

3.4.3. Linking Health Centre Service with Pharmacy

Currently, the practice is that patients physically take their prescriptions to the pharmacy which is located elsewhere on campus. Some patients are of the view that the services provided by the two units should be linked together. Stated below is the suggestion made by a respondent.

• The doctors could send the prescriptions to the UTech’s pharmacy, which would make the filling of the prescription faster. The pharmacy service is very slow, and this increases the waiting time before getting the medication. (Female student, ≥50 years).

3.4.4. Time Management

Some of the respondents were of the view that there is a time management problem with the online scheduling system. They are of the view that with more doctors, the consultation time could be managed properly. Hence the suggestions made below.

• At times, there are available time slots, but there are no doctors. Engage the services of more doctors and try to allocate more appointment spaces for customers, if possible. (Male student, ≤20 years)

• There is a need to get more doctors on board and standardise the amount of time the doctors spend with a patient. (Female student, 21 - 30 years)

• In the study conducted by Braddock and Snyder, they stated ethical obligations should guide physicians about time management [31] . They added that “as such, judging the adequacy of time in clinical practice requires that we call on the ethical principles and values inherent in medicine” [31] (p. 1056).

3.4.5. Educating the Users

Some of the respondents were of the view that more information about the health centre and its services should be provided. Hence, some have made suggestions on how to disseminate this information to the users.

• Not everyone is familiar with the acronym on the website as it relates to the online scheduling. There is a need to make the information clearer on the university website. (Male student, 21 - 30 years)

• Place notices around the campus to make users more aware (Male student, 21 - 30 years)

• Have a worksheet instruction flyer on how to use the online scheduling system, and make it more user-friendly. (Female student, 31 - 40 years)

4. Discussion of Results

In research question one, 92.0% of the respondents had visited the health centre and had used the online scheduling system. Fifty percent of the respondents were made aware of the online system by the health centre staff; this showed that the dissemination of information about the system was limited. Cao et al. recommended the need to better promote the use of the WAS among the patients [7] .

The findings showed that approximately 76.0% of those respondents who had used the online scheduling system before were either satisfied or very satisfied, and also found it to be user-friendly. This is consistent with the findings of other studies [7] [32] . Cao et al. found out that patients in primary health care clinics in Saudi Arabia and China, respectively, were satisfied with web-based/online appointment systems when compared to those who use the queuing method who experienced a longer waiting time [7] . In a study conducted in Iran involving the use of 425 women, Sadjadian, Kaviani, Yunesian, and Montazeri, they found that 82% of the women were either satisfied or very satisfied with the clinic’s overall performance [12] . Furthermore, the findings are also consistent with the literature, which also found that participants in their studies were satisfied with the services provided at their health facilities showed that [4] [13] [14] [15] . On the contrary, a study by Al-Refaie in Jordanian hospitals, indicated dissatisfaction of the respondents with service quality [16] .

Regarding research question two, for the 13 Likert-type items, the percentage of agreement between the students and the staff who responded were between 64.0% and 98.0%. This showed that a majority were in agreement with their responses to the items.

However, there were statistically significant differences in the views expressed by the students and the staff on two items: “I am satisfied with the services provided by the doctors,” and “I am clear about the procedure to access the different services.” This was because of the mean difference. The mean for the students was (M = 3.53, SD .57) and (M =3.45, SD = .76) for the staff for the services provided by the doctors. This finding is consistent with the study done by Panda, Sinha, and Soni in India, which showed that 49.5% of the respondents rated the services by doctors as excellent [13] . In another study by Sadjadian et al. [12] , the physical environment and the doctors’ consultation style were the reasons why the women’s overall performance satisfaction was high. For the statement “I am clear about the procedure to access the different services,” the values were (M = 2.57, SD = 0.82) for the students and (M = 3.35, SD = 0.75) for the staff. No study was found to support this finding.

Regarding the health centre and pharmacy services, due to lack of physical space, it will be hard to have both within a locality. In a commentary written by Inguanti [24] , it was noted that pharmacy services that are located in health centres play an important role in providing services within the same location. However, in the current study, for medications that are available in the university pharmacy, the researchers support the view that doctors could send the prescriptions to the university pharmacy, which would make the filling of the prescription easier for the patients and a little cheaper. Inguanti [24] , and Wright, Gorman, Odorzynski, Peterson et al. [25] acknowledged that the physical proximity of a pharmacy to a health centre tend to have a cheaper rate for the patients.

5. Conclusions

The online appointment system is gaining more popularity and due to its numerous benefits such as minimising waiting time, patients being able to schedule their appointment without using the walk-in method, getting email appointment schedule reminder, and among others. To some scholars, it is regarded as a win-win solution for patients and physicians. Despite its several benefits, the online scheduling system is also affected by several factors such as availability of information technology, issues with consultation time, and the experience level of the scheduling staff.

This study was designed to provide evidence on the users’ views of the online scheduling system, its benefits and challenges. The findings showed that the views of the users about the online scheduling system were positive. There was a significant difference in the views of the students and staff on two of the 13 Likert-type items that measured the services provided at the health centre. The respondents were provided comments on how to improve the online scheduling system and services at the health centre.

Although the findings of this study cannot be generalised due to the sample size used, the results could be used to improve the online appointment system as well as other services offered at the health centre. Based on the findings of the study, the following recommendations are made:

1) Use of a bigger sample size in future studies to make it possible to generalise the findings.

2) Ensure that more patients who continue to use the online appointment system find the experience satisfactory. This could be achieved by minimising the waiting time to see a doctor.

3) Advertise the online system not just by the health centre staff but electronically throughout the university community and also seeking suggestions on how to further improve the system.

4) Ensure that the doctors try to be on time to see patients who have already made such appointments.

5) Facilitate the patients whose prescriptions could be filled at the university pharmacy through the use of technology.

6) Engage the services of more doctors to better manage the consultation time between the doctors and their patients.

Conflicts of Interest

The authors declare no conflicts of interest.

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Philippine E-Journals

Home ⇛ jpair multidisciplinary research journal ⇛ vol. 9 no. 1 (2012), automated class scheduling system.

Jeralyn M. Gamale | Edward C. Anuta | Zina D. Sayson

Discipline: Education

<p style="text-align: justify;">The study tested the functionality of Automated Class Scheduling System in terms of speed, data handling, accuracy, security, stability and adaptability in making class schedules. This study was conducted in Bohol Island State University Main Campus, Tagbilaran City during the second semester of school year 2010-2011. The respondents of this study were the 6 expert instructors in the field of computer programming. They tested and evaluated the functionality of the program in terms of its design, accuracy, data handling, security, stability and adaptability. Another 8 instructors who are in charge of making class schedules determined the functionality of the system in terms of speed, accuracy, data handling, stability and adaptability of the software. Separate set of questionnaires were given to two groups of respondents. The study concluded that the manual and the automated class scheduling systems are both functional. However, the automated system is more functional because of its extra features which solve the primary problems in creating class schedules.</p>

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ISSN 2244-0445 (Online)

ISSN 2012-3981 (Print)

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