ONLINE POLYCLINIC

APPOINTMENT AND DATABASE

MANAGEMENT SYSTEM

Maryam Tufail

Master’s thesis
August 2018
Master’s Degree in Information Technology
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ABSTRACT

Tampereen ammattikorkeakoulu
Tampere University of Applied Sciences
Master’s Degree in Information Technology

MARYAM TUFAIL

Online Polyclinic Appointment and Database Management System

Master's thesis 43 pages, appendices 1 page

August 2018

The objective of this thesis was to develop an Online Doctor's Appointment and
Medical Database Management System in Pakistan. The purpose of implementing this
application was to create a system through which a patient can easily compare, choose
and make an online appointment for a doctor just by sitting at home. The second
objective was to replace manual medical file keeping system with online database
management system.

The reason behind creating this system was the “trend of private medical clinics” and
manual medical file keeping system in Pakistan. Online appointment and database
management system aims to improve quality medical care by bringing all medical
clinics of the city at one platform, eliminating long waiting lines and replacing manual
medical file keeping with an online database.

The application was successfully implemented by using famous technologies and

programming languages. This application does not aim to target any specific group but
every individual who wants to seek medical help and that is why it was kept in mind to
keep the user interface simple and friendly while building this application. Like all other
applications, this application also has a client side and a server side. This application
was developed by using HTML, CSS, and JavaScript at the client side while PHP and
MySQL on the server side.

For now, basic functionalities have been implemented but for the future, work will be
done to link pharmacies and laboratories to the system. Online follow-up for the distant
patients is another feature that is aimed to add at later stages.

Keywords: online appointment, database management, online database.

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FOREWORD

I would like to thank my supervisor ’Erkki Hietalahti’ for his guidance and help during
my thesis work.

Maryam Tufail

Tampere, August 2018

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CONTENTS

1 INTRODUCTION ............................................................................................. 6
1.1 Main Purpose ............................................................................................. 7
1.2 Objective of the Project ............................................................................. 7
1.3 Aim of the Project ...................................................................................... 8
1.4 Project Scope ............................................................................................. 8
1.5 Study Limitation ........................................................................................ 8
2 LITERATURE REVIEW .................................................................................. 9
2.1 Waiting time .............................................................................................. 9
2.2 Appointment Delay .................................................................................... 9
2.3 Managing Patient’s Appointment ............................................................ 10
2.4 Online Booking ........................................................................................ 10
2.5 Existing System ....................................................................................... 11
2.5.1 Determination of Problem............................................................. 11
2.5.2 Proposed System ........................................................................... 12
2.6 Patient’s Appointment Time .................................................................... 13
2.7 APPLICATION TECHNOLOGIES ........................................................ 13
2.7.1 Web Server .................................................................................... 13
2.7.2 Programming Languages .............................................................. 14
2.7.3 Software Tools .............................................................................. 17
3 SYSTEM ARCHITECTURE .......................................................................... 18
4 REQUIREMENT AND SYSTEM DESIGN .................................................. 19
4.1 System Overview ..................................................................................... 19
4.2 Use Cases ................................................................................................. 19
4.2.1 Patient Use Case ........................................................................... 21
4.2.2 Doctor’s Use Case ......................................................................... 25
4.2.3 Admin Use Case ........................................................................... 30
4.3. System Design ......................................................................................... 32
4.3.1 Class Diagram ............................................................................... 32
4.3.2 ER Diagram .................................................................................. 33
5 SYSTEM IMPLEMENTATION AND SOFTWARE TESTING .................. 35
5.1 System Testing......................................................................................... 35
5.2 User Interface Layout .............................................................................. 36
5. DISCUSSION ................................................................................................. 39
REFERENCES ..................................................................................................... 41
APPENDICES ...................................................................................................... 43
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ABBREVIATIONS AND TERMS

CSS Cascading Style Sheet

ER diagram Entity Relationship diagram
HTML Hypertext Mark-up Language
JavaScript Scripting programming language
MySQL Open source database
PHP Server-side scripting language
TAMK Tampere University of Applied Sciences
UI User Interface
XAMPP X-OS, Apache, MySQL, PHP, and Perl
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1 INTRODUCTION

Health care is one of the fastest growing industry all over the world. Before the last few
years, medical appointments were usually taken on the phone calls or by visiting the
hospitals in person. This process needed the involvement of individuals so, the ability to
take appointment was restricted to the availability of schedulers, phone lines or the
physical presence of a person.

With the growth of time, everybody demanded timeless and efficient medical care
delivery because manual appointments (that requires the physical presence of both
individuals) and long waiting lines have formed an irritating situation for the healthcare
institutions. So, it created a need for such an integrated health care system that could
deliver seamless care to both outpatients as well as inpatients. The emergence of online
appointment system offered timeless and efficient access to health care services.
Therefore, for hospitals and other medical societies, online appointment booking has a
great importance and a subject of interest (Koole, 2007).

Booking appointment online has become a new trend in the past few years and is
considered as one of the key processes in the healthcare industry. Bailey (1952)
considered scheduling system as a trade-off or a compromise between a doctor and
patient’s waiting times. Patients who get late for the appointments or who fails to come
becomes the reason for the underutilization of a doctor’s time. Idle time and
underutilization of doctor’s time are also resulted by gaps in the appointment times
(Bailey, 1954).

Different researchers agreed that main patient dissatisfaction is caused by long waiting
times. Cayirli (2003) defined access time as the time between patients’ request for the
appointment and the time he is checked up. According to Veral, waiting time is the time
between consultation and the scheduled time while neglecting the early arrival of a patient
(Veral, 2003). Different researchers defined waiting /access time in different ways. A
well-designed appointment system supposed to improve patients’ satisfaction by
reducing cost and time of clinics and hospitals especially in the busy lives we are leading
today.
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With the growing population need for more efficient ways to access a medical treatment
is also growing. Through an online appointment scheduling system, a user gets access to
the doctor's online webpage and can make an appointment with online software.
Patient/user can also provide additional medical history in advance, giving adequate time
to the doctor to prepare the necessary information for consultation. In this way, online
appointment scheduling systems are helping doctors and the patients and making the
healthcare delivery efficient.

Nowadays there are many kinds of online appointment tools available in the market which
are easy to set up and not too much expensive. Online scheduling system offers value-
added services and lots of benefits to the doctors and patients. It makes the patient
appreciated by eliminating the hassle of long waiting times. Online appointment systems
are also getting popular because of its low-cost availability.

1.1 Main Purpose

The main purpose of this project is to link and bring all major private medical clinics of
the city (of my country) to a single platform. So that patients can easily get access to the
doctor's profile and make online appointments. The second purpose is to create an online
medical history database so that doctors and patients can freely exchange patients'
medical history information much easier, faster, and safer.

1.2 Objective of the Project

The main objective of the thesis is to provide quality medical care to the patients by
bringing all medical practitioners of the city to a single platform so that everybody can
easily access them and make appointments. The second objective is to replace the current
manual file keeping system with an online medical patient database system.
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1.3 Aim of the Project

The aim of this project is to create a platform where patients and doctors can access
/interact efficiently with each other and provide ease and comfort to the patients. It also
aims to resolve the problems that patients have to face while taking appointments and
keeping medical files. Patients can choose a medical practitioner based on their
professional profile and other patient's reviews. While doctors can access and update a
patient’s medical record after every checkup.

Following features will be added in the future:

• Online follow up with doctors (specially for distant patients)

• Linking laboratory and pharmacy so that medical store administrator can view
suggested prescription and laboratory can view clinical tests recommended by
the doctor. This feature aims to eliminate paper-based prescriptions.

1.4 Project Scope

This system is implemented for all the individuals who want to get treated by the city
practitioners. The users can participate only if they have created an account through the
registration form and have provided their medical history. Once they get registered
themselves further they would not need to update their record as it would be done
automatically after each doctor’s visit.

1.5 Study Limitation

The lack of time was the main the limitation. Secondly, because there is no such system
in my country so there may be some difficulties to implement and convince people to use
this system.
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2 LITERATURE REVIEW

2.1 Waiting time

Fernandes et al. (1994) defined waiting time as the period of time an individual wait until
a specific action occurs. Waiting time was also defined as the time a patient entered a
clinic or service point and gets consulted by a doctor with a prescription in his hand.
There are two different ways in which the waiting time has been defined in the past. At
first, waiting time is the time that starts when an individual comes for the appointment
and it continues until the individual gets consulted by the doctor. In the second definition,
it starts when an individual comes for taking appointment and ends when he got
prescribed medicine after being consulted by the doctor.

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.

It has also been stated that the appointment system has no benefit for the patients not
seeing the doctor or who are taking routine repeated medication. Later it was realized that
the block appointment system offers shorter waiting time only for acutely ill patients and
not for others.

2.2 Appointment Delay

It has been proved in the past research that there is a direct relationship between
appointment delay and cancellation of the appointment. Appointment delay is defined as
the time which starts when an individual request for an appointment and ends until he/
she gets consulted by the doctor. Longer appointment delays cause more appointment
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cancellations. So, the best way to reduce appointment cancellations or no-shows is to

minimize the time gap between the appointment request and doctor’s check-
up/consultation time. Minimizing this gap is called open access (abbreviated as OA) or
advance access policy which later became a popular practice and part of an active research
also. Both positive and negative results were experienced by the researchers in their
experiments. Some practitioners were in the favor of OA and highly recommended it, and
on the other hand, there were some practitioners who disagreed and were against of OA
implementation.

2.3 Managing Patient’s Appointment

In a health care centre, an application which is used to manage and minimize patient
waiting time is called managing patient's appointment system. Some health care clinics
use this kind of applications while some do not. Medical clinics who use such
applications usually have shorter waiting times as compared to those medical clinics who
do not use any appointment application. Patients who supposed to wait more than an hour
for their medical check-up feel disgraced and unfair. Patients can evaluate the quality of
any medical centre based on the waiting time they have to experience. Therefore, it has
become important to consider factors like “saving time” and “minimizing idle time” while
developing any patient’s appointment system. Whereas according to Klassen (2002),
scheduling doctor’s time and patient’s appointment supposed to depend on the
seriousness of the case and patient’s need.

2.4 Online Booking

An online appointment system is a web-based system which is made up of independent

components or web pages, working together for a common purpose. Such systems are
available on the internet for the users to accomplish some purpose.

James (1999) defined internet as a system which provides an opportunity to millions of

people to get access to a large amount of stored data and get connected to each other
despite distances. Increased rate of missed appointments and patient dissatisfaction
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pushed to recognize the need for better-quality care services. With the advancement of
information technology and the sensitive situation of medical care, online appointment
system emerged as an important output for efficient and timely delivery of health care
services. Earlier, appointment requests were used to make through the phone call, email
or fax but with the advancement of technology and internet, the trend changed towards
the proper online appointment systems.

According to Gruca (2004), a patient can make an appointment for a doctor either by
going directly to the doctor's clinic or making a manual appointment through the phone
call or sending the email. With the emergence of the internet, health care centres can
connect and communicate with their patients efficiently. Therefore, many healthcare
centres have started using online appointment systems. Such systems ensure efficiency
and effectiveness.

2.5 Existing System

In Pakistan, there is a huge trend of private medical clinics and hospitals. Doctors run
their own private clinics and consult patients during the evening or any time of the day
depending on their availability. Some are popular and known to all while some are known
by few people. This situation proves to be a challenge for new practitioners as they are
known to very few people even if they have a good academic background. On the other
side, patients also face difficulty in finding and choosing a nearby doctor. Unscheduled
appointments, long waiting lines and keeping medical files in physical form are also the
common problems faced by the people/ patients of Pakistan.

2.5.1 Determination of Problem

Challenge for new practitioners

Starting a private clinic can be a challenge for new practitioners. For example, if a new
doctor wants to open his clinic there is no platform exist, by which or from where people
can get to know about his clinic.
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The problem for a new individual in a city

In the same way, the same problem goes for any person new to the city as he is unknown,
who is the best or closest doctor/clinic to go for a medical checkup.

Long waiting lines

To get doctor's consultation, patients come twice to the clinic once for taking the
appointment and second time for the checkup. Some patients visit the doctor without any
prior appointment resulting in a long waiting time. There is also a possibility that they
don't consultation by the doctor even after a long waiting line.

Managing paper-based medical files

Patients must carry their medical related report or files every time they visit a doctor. And
sometimes they lost their files too.

2.5.2 Proposed System

In “Online Polyclinic Appointment and Database Management System” I have tried to

consider all of the above problems with the existing system in Pakistan. My objective
was to provide a platform where all practitioners and patients can be brought together. In
this application, all practitioners either new or working for a long time can sign up
themselves. This way people can get to know and choose to visit any doctor of their
choice. By using this application user will be able to know and access the professional
profile of each registered doctor from all specialties. Doctor’s profile includes
information regarding their professional experience, practicing license, educational
background, clinic timings, working days, clinic accessibility and other patient reviews
also. Users would be able to book appointment sitting at their homes. The user can choose
a doctor close to them or have more professional experience or have more good reviews
from the other patients. New practitioners can easily join the platform and start taking
appointments without the need of any expensive advertisement.

When registering as a patient, the user can give all necessary medical history so that he
doesn't need to keep or bring his medical file when going for a check-up. Every time
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when a user books his appointment, the doctor can easily get access to the patient’s profile
and also update medical record.

2.6 Patient’s Appointment Time

Scheduling appointments for the patients started long years ago. Primarily appointment
system was developed to minimize doctor’s idle time because it was thought that doctors
time is more valuable as compared to the patient’s waiting time. But later it was realized
that the importance of minimizing the patient's waiting time is as important as the doctor’s
time. So now while developing an appointment system doctor's idle time and the patient's
waiting time both factors are given equal importance. Patient’s scheduling also includes
improving quality health services, reducing doctors and nurses idle time and reducing
patient’s waiting time.

2.7 APPLICATION TECHNOLOGIES

The purpose of this project is to build an Online Appointment and Database Management
System. It is important for the user to understand how this application works and knowing
the technologies that are used to implement this project. For a better understanding, all
steps are described in detail to give a full overview of the system.

2.7.1 Web Server

Role of a web server is to communicate between the client side and server side by storing,
processing and delivering web pages to the client side. Usually, web browser initiates the
communication using HTTP by sending the request of a specific resource and server gives
the response with the content of that requested resource. For this project work, Apache
HTTP server was chosen, and it exists on the WAMP service. Apache HTTP server is
one of the popularly used web server software used in a lot of project works.
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Apache web server

Apache web server is a free, open source and most popularly used software. Apache web
server is used by many famous websites such as Apple, Wikipedia, and PayPal. Another
reason for its popularity is that it can run on multiple operating systems such as Linux,
UNIX, windows, and macOS. Another feature of Apache web server is that it can host
websites which use server-side language code (Perl, PHP). Because in this project server-
side implementation is done by using PHP so Apache was a good choice.

2.7.2 Programming Languages

In this project, PHP was chosen as a server-side programming language and MySQL was
selected as a backend database. HTML, CSS, and JavaScript were used for the client-side
work.

PHP

PHP is a server-side programming language commonly used to develop dynamic web

pages. It is free and accessible in numerous different versions. It can be used on multiple
OS such as macOS, windows, UNIX and different platforms. Because it is a scripting
language so in this program code is taken after the program execution. PHP can also be
used in desktop applications.

One of the reasons for choosing PHP in this project is that it supports MySQL which is
chosen as a database in our project. PHP programming language makes easy to present
images and PDF files on HTML pages.
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Client-side programming

For the development and designing of web pages HTML, CSS and JavaScript languages
were used. HTML for creating the web pages, CSS for styling and for adding further
functionalities JavaScript was used.

JavaScript

JavaScript is dynamic, high-level scripting language and considered to be one of the core
three technologies of the world wide web. It is considered an important part of a web
application. It is used for adding functionalities and making web pages interactive. In
simple words, it informs the browser about a certain activity or event that occurred and
changes the web page as a response to that event, for example, a click on a button.

HTML

Hypertext markup language (HTML) is used for creating web pages and web
applications. It describes the structure of the web pages. Information from the HTML
documents is sent to the web browser to render or display on the multimedia pages. Html
used to describe the structure of a document by presenting a document in a heading,
paragraph, image, list, links and other objects like that. Web browser presents the HTML
document by using its tags.

CSS

It is important to make HTML pages attractive to the users and for this purpose,
developers choose colors, nice fonts, and different layouts. All this work is done by the
CSS. In short, CSS is used for styling of a HTML document. It is designed in such a way
that enables separation of content and presentation so that it makes easier any change of
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content without interfering with a design. It also enables multi web pages to share the
single CSS file for styling to reduce repetition and complexity.

Backend technology

For this project work, MySQL was chosen as a database.

MySQL

It is an open source relational database management system which aims to offer multiple
user access to several databases. In simple words, a database is a collection of data which
can be a list of shopping items, number of items in a shopping centre or even a vast
amount of numerous data in a corporate network. To manage such kind of data, a database
management system is required such as MySQL which aims to access data and perform
functions like add, remove or edit data. Since MySQL is a relational database so it stores
data in different tables instead of putting into a large storeroom. Storing /organizing data
into tables increases the accessibility speed and flexibility.

Applications which demand availability and scalability use MySQL. Because it has the
capability to recover and cope with failures on the host, MySQL, operating system or the
hardware that may cause downtime. Scalability refers to the ability to spread the database
as well as application queries. MySQL is reliable for data security. MySQL has a good
memory management system and provides multiple development interfaces (ODBC,
JDBC).

Since MySQL is a free open source software so anyone can download it without paying
anything and make changes into the source code. For this project, MySQL was chosen
because it is very easy to use and PHP's ability to work with MySQL.
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2.7.3 Software Tools

For this project work following source tools were chosen to perform various tasks:

Notepad++
Notepad++ is an unrestricted, plain text editor used widely by developers for Microsoft
Windows. Notepad++ supports several languages and is used to write and edit code. In
this project Notepad++ is used to write HTML, CSS, PHP and JavaScript codes. Its main
features include syntax highlighting, correcting and auto-completion.

XAMPP Server
XAMPP is a free and open source software which empowers technologies, processes, and
machines to link and work together. It is established by Apache. It stands for x-OS,
Apache, MySQL, PHP, and Perl and used as a stage for coding and designing web pages.

Xampp is very easy to install and has the capability to run on several platforms. Xampp
has very strict security settings and with a single command it can start and stop the server.
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3 SYSTEM ARCHITECTURE

The system architecture of this system is divided/split into two parts. One is the client
side and the other is the server side. Client-side is the user interface whereas the server
side is the combination of web pages written by PHP and the MySQL database. PHP
pages contain the written SQL queries which make the accessibility to database
possible. The following figure shows the architecture of the system while the detail of
the technologies used in this application is discussed in chapter 2.
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4 REQUIREMENT AND SYSTEM DESIGN

4.1 System Overview

We are implementing a web-based appointment system in Pakistan for booking an online

appointment and keeping an online medical history. Users can sign up online, search for
the nearby doctor and book appointment while sitting at their homes by using a web
browser. Two different types of actors are using this system: user actor (patient), which
can be registered to the system, search for the doctor and book an appointment.
Administrative actor (doctor/ physician), which can log in to the system with a username
and password, accept patient's appointment request and update medical record after each
visit. The functionality and more features are explained in more detail in this chapter.

The main characteristics of the system are:

• Every individual either a doctor or a patient will have an independent id, name and a
profile. Doctors are further categorized by the specialty of practice (i.e. Obs/Gyne,
Urology, Internal Medicine etc.)

• The user (patient) can get, change or cancel appointment time and view medical record
while the doctor can make changes in his calendar and accept or reject appointment
request by log in to the site and accessing his/her personal page.

4.2 Use Cases

To explain the better view and functionalities of the system, use case diagrams are chosen.
The use case diagram is important to document the requirement of the system as well as
to specify functionalities of the system. Use case diagrams better explain the way the user
interacts with the system.
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Figure 1: Use Case Diagram

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4.2.1 Patient Use Case

Figure 2: Use Case for Patient (user)

Use-Case 1: Registration

Primary-actor: generic user/patient.

Description: To make an appointment, user registration is required.

Precondition: National ID card and valid email address.

Basic use-case flow: For the registration process, the user/patient needs to give some
information by filling the form. Some of the required information includes the following:
First name
Last name
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Gender
Email address
National ID no.

Main scenario: The user/patient will go onto the patient sign-up button either from the
main page or from the drop-down menu. After clicking the sign-up button, a registration
form will appear, where the user must give his personal information i.e. name, gender,
email address, CNIC, any medical history etc. After giving the required information user
will submit the form. If all the fields are filled including the valid email address and
CNIC, the user will be registered onto the system. In case of any missing entry or invalid
format of an email or CNIC, the error occurs onto the page.

Exception: Expired/invalid National ID card no or email address.

Use-case 2: Login

Primary-actor: Patient/user.

Description: Before taking any appointment or get access to his medical record, the user
must have to provide his username and password.

Precondition: the user must have a valid username and password.

Basic use-case flow: a valid username with a password must be entered by the user.

Main scenario: To be able to get into the system, the user needs to enter his username
and password either from the main page or from the drop-down menu from the top of the
page. After clicking onto the login button, authentication request will be forwarded to the
system.

Exception: wrong/invalid entered username or password.

Use-case 3: search for a doctor

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Primary-actor: User patient/generic user

Description: In this use-case, any registered or unregistered user, can look and search for
a doctor of any desired specialty.

Precondition: this use-case has no exception.

Basic use-case flow: By going into the category of any specific specialty, the user can
view the list of all registered doctors.

Main scenario: The user will go to the down menu at the top of the page. A list of all
specialties will appear in a drop-down list. The user will hit on the desired specialty. After
that, a page will open with all doctors of that specific specialty. Now the user has the
choice to choose any doctor based on qualification, experience, location etc.

Exception: no exception for this use-case.

Use-case 4: Take Appointment

Primary-actor: User/patient

Description: After choosing a doctor user will go further to send an appointment request
from the available timings.

Precondition: the user must be login

Basic use-case flow: The patient/user hits the button for taking an appointment for the
doctor. A list of available timings will appear for the chosen date. The user will select the
suitable time for him and send the request for approval.
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Main scenario: The user will hit the button for "take appointment". List of available
timings will appear for a chosen date. The user selects the suitable time. The user will hit
the submit button to send the request for approval.

Exception: this use-case has no exception.

Use-case 5: View history

Primary-actor: User/patient

Description: the user can view his medical history.

Precondition: the user must be signed in.

Basic use-case flow: The user/patient will click on the name of the patient and it opens
the patient's profile. By going into it the user can view the history by clicking on the
button for the patient’s old reports/history.

Main scenario: The user clicks on the name of the patient and then press the button “view
history” to view old reports.

Exception: no exception for this use-case.

Use-case 6: Log out

Primary-actor: User/patient

Description: the user will log out from the system.

Precondition: the user must be logged in

Basic use-case flow: the user can sign out himself from the system.
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Main scenario: the user clicks on the log out button. The system will bring the user to
the main page for the generic user.

Exception: no exception for this use-case.

4.2.2 Doctor’s Use Case

Figure 3: Use Case for Doctor (user)

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Use-case 1: Registration

Primary-actor: Generic user/doctor

Description: To get online appointment requests, the doctor must register himself as a
user on the application/system.

Precondition: National ID card and active email address.

Basic use-case flow: To register as a doctor, the user must fill the form. Required fields
include the following information:
Full name
Email address
National identity number
Qualification
Experience
Valid PMDC certificate (Practicing license issued by the PMDC authority)
Clinic address
Clinic timings

Main scenario: The user/ doctor has to go onto the doctor’s sign-up button either from
the drop-down menu at the top or from the main page. After clicking the sign-up button,
a registration form will appear, where doctor/user has to give his personal as well as
professional information i.e. name, clinic address, qualification, working experience etc.
The user must give valid PMDC certificate for the registration process. After giving the
required information user/ doctor will submit the form. If all the fields are filled, request
for registration will be sent to the admin. As soon as admin receives a request for a
doctor's registration he will verify his documents and only then the user will be accepted
/registered. In case of any missing entry or invalid format of email or CNIC, an error
occurs onto the page. PMDC certificate is a license or a proof that an individual is allowed
by the authority to practice medicine. Any user fails to give valid PMDC certificate issued
by PMDC authority will not be allowed to register as a doctor. PMDC certificate is
important to avoid any scam.
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Exception: False documents, expired or invalid PMDC certificate, missing fields,

expired national ID card or inactive email.

Use-case 2: log in

Primary-actor: User/doctor

Description: For further functions, the user must have to provide his email address and
password.

Precondition: the user must enter the username and password.

Basic use-case flow: user/doctor should provide his username and password to log in.

Main scenario: To be able to get into the system, the user needs to enter his username
and password either from the main page or from the drop-down menu from the top of the
page. After clicking onto the login button, an authentication request is forwarded to the
system.

Exception: occurs if fails to provide username and password.

Use-case 3: View calendar

Primary-actor: User/doctor

Description: User would be able to view his calendar.

Precondition: The user must be signed in.

Basic use-case flow: After logging in, the user/patient selects the date from the calendar
to filter out the appointment.
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Main scenario: After signing in, the user/doctor can view the page of his calendar. The
user will select the month and date to see the appointments of that period or date. The
user can view all the patient's appointments of any date.

Exception: no exception for this use case.

Use-case 4: Accept or reject a request

Primary-actor: User/doctor

Description: User/doctor can accept or reject any patient's request.

Precondition: User/doctor must be signed in.

Basic use-case flow: User/doctor selects any date and decides to accept or reject any
appointment request.

Main scenario: After logging in, all the patient's appointment requests will be appearing
on the calendar according to the dates. User /Doctor will select the date from the calendar.
User /Doctor can view all the appointment requests. User /Doctor can select the option to
accept or reject the appointment request from the drop-down menu.

Exception: no exception for this use case.

Use-case 5: View patient

Primary-actor: User/doctor

Description: User/doctor would be able to view the patient's detailed information

including his/ her medical history.

Precondition: User/doctor must be signed in

 29

Basic use-case flow: After selecting the date, user/doctor selects the patient. User/doctor
can view the patient's detail and medical history.

Main scenario: After selecting the date, list of patients of that particular date will appear.
User /Doctor will select the patient. User (doctor) can view his all information including
the medical history by clicking on the "view patient" button

Exception: no exception for this use case.

Use-case 6: Add comments

Primary-actor: User/doctor

Description: User/doctor would be able to write his own comments into the patient's
medical profile.

Precondition: User/doctor must be signed in

Basic use-case flow: After clicking on the "write comments" button, user/doctor can add
his own reviews after checking the patient.

Main scenario: User/doctor will hit the "write comments" button. User (doctor) will
write his or her comments. User/doctor will hit the submit button.

Exception: no exception for this use case.

Use-case 7: log out

Primary-actor: User/doctor

Description: the user/doctor will log out from the system.

 30

Precondition: the user/doctor must be signed in

Basic use-case flow: the user/doctor can sign out himself from the system.

Main scenario: the user/doctor clicks on the log out button. The system will bring the
user to the main page for the generic user.

Exception: no exception for this use case.

4.2.3 Admin Use Case

Figure 4: Use Case for admin

Use-case 1: Login

Primary-actor: Admin/administrator

Description: A user, who possesses admin username and password, owns administrative
rights.

Precondition: username and password.

 31

Basic use-case flow: Admin/user needs to provide the username and a password.

Main scenario: Admin/user enters valid username and password. After verification, the
user will be logged in as an admin and can use all the administrative rights.

Exception: occurs if user provides wrong username/password.

Use-case 2: Manage users

Primary-actor: Admin/user

Description: User/admin can use his administrative rights.

Precondition: the user must be logged in as an admin.

Basic use-case flow: Admin/user can view, edit or delete any user information.

Main scenario: Admin can view, edit or delete any user or any information related to
user doctor or user-patient.

Exception: no exception for this use case.

Use-case 3: log out

Primary-actor: Admin/user

Description: Admin will log out from the system.

Precondition: Admin must be signed in

Basic use-case flow: User signs out himself “as an admin".

 32

Main scenario: User clicks onto the logout button. The system will remove information
from the local storage and brings the user to the homepage.

Exception: no exception for this use case.

4.3. System Design

4.3.1 Class Diagram

The class diagram is chosen to explain the design phase of the system. A class diagram
describes classes of the system, attributes, and operations and relationships of the
classes in a better way. We can also say that class diagrams are used to justify the
structure or behavior of use cases of the system. Class diagrams best explain the
conceptual model of the system in terms of entities and their relationships. The class
diagram looks like a shape of a rectangle, comprising three compartments stacked
vertically. The first top box comprises the class name, the second middle box contains
the attributes of the class and third the last box contains the methods or functions
performed by that class. The first compartment /box of the name is compulsory while
rest of the two can be omitted to simplify the diagram. So, in any class diagram first
compartment must be drawn while the second two compartments are optional.

The class "patient" contains multiple parameters (such as id, name, age, address), which
depict the information of all the registered patients. The user class also contains the
methods performed by these users such as get appointment, view/ create own medical
record etc. In the same way, the class "doctor" has the parameters id, name, department,
address possessing all the required information of the users registered as a doctor on to
the system. Methods include accept/reject the appointment, check the patient, view a
medical record of any patient etc. These methods are the functions performed by the
users registered as a doctor on the system. The class “appointment” has the parameters
of date and time, explaining what time or day patient user has requested for the
 33

appointment to the doctor. The class “department” has the parameters id and name and
methods include add/ delete doctor and add or delete department. Every doctor user
must belong to any department class. The “report” is another class containing methods
like write report or prescribes medicine. In the end, class “admin” contains the
parameters like id and name and methods of this class include manage users.

Figure 5: Class Diagram

4.3.2 ER Diagram

A basic ER model consists of objects called entities and specifies relationship among
those entities. Purpose of this diagram is not to define any functionality rather show
association and dependency among entities. ER diagram is drawn with "rectangular
boxes" as entities and the "straight lines" showing the relationship between these boxes.
An entity is an object or a thing that has an independent existence and can be easily
differentiated from others. Each entity has some attributes like name, age, address,
department etc. In the following diagram the doctor, patient, appointment, admin etc, all
are different entities. So, an entity can be a person, animal, plant, event or a company.
 34

Entities consisting of similar attributes make the entity sets. These entities have some
association among each other which make a relationship. These relationships can be "one
to one" or "one to many" or "many to many". For example, a doctor and department can
have "one to many" relationships, means one department can have many doctors but one
doctor is related to only one department.
Figure 6: ER Diagram
 35

5 SYSTEM IMPLEMENTATION AND SOFTWARE TESTING

5.1 System Testing

For the sake of software quality assurance, system testing is a very essential thing to do.
It is a process by which we try to make the system error proof by performing the
program to find an error. The goal is to run the program, find errors or bugs and then fix
them. Testing is considered a very essential step in software development and any
system is not considered to be complete without this process. Different developers
follow different approaches for system testing. System testing is followed to make sure
that system is working fine and meets the requirements.

Tes Test case Preconditio Priorit Input Steps to Expected Successfu

t name n y test data be Result l or not
cas executed
e
ID

1 User_reg no high Valid Need to Registratio OK

email fill the n
address registratio successful
or n form
correct and
national submit
ID card
no

invalid Error Error

email message
address
or
incorrect
national
 36

ID card
no

2 User_logi Must be high Valid Enter A OK

n registered usernam username successful
earlier e and and login to the
passwor password system
d and
submit
Invalid Login Error
usernam failed, and
e or the system
passwor displays an
d error
message

5.2 User Interface Layout

This online clinical appointment system is the first system to be implemented in Pakistan,
so it is very important to keep the interface simple and easy to be easily understood by a
user. For this purpose, simple and common UI elements are used. It makes the common
user to easily understand the system and get used to it. The below-given figure shows the
prototype of the system. There is a horizontal menu list on top of the home page. This
menu list contains drop down buttons such as specialization, patient, doctor, and contact.
All these buttons open a new webpage. When a user brings cursor onto the specialization
button, a drop-down menu list appears showing/ containing all the existing departments.
All doctors are classified based on the departments or specialty. The user can choose to
view the doctors of any specific specialty by clicking on this button. Next comes the
button for the doctor. The user can register himself or sign in if he already has an account.
Next button on the menu is for the patient, the user can again sign up or sign in if he/she
has already an account. The last button on the menu bar is of “contact us”. Any user can
call or send an email to the admin by using this option. This page contains all the
information or possible ways to contact in case of any need. When we go down of the
homepage there is a big picture to make the page look good and then again there are two
blocks for the doctor registration/ sign in and patient registration/sign in.
 37

Figure 7: Layout part 1

Figure 8: Layout Part 2

 38

Figure 9: Layout part 3

 39

5. DISCUSSION

After coming to Finland and experiencing such an organized and centralized health care
system for the public, I also decided to make a similar application for my country. Of
course, the scope of the application I am developing is not too big, but I hope at least it
would be a good solution to the prevailing problems of my country. As I have
mentioned earlier there are a lot of small clinics in every next street, creating a very
confusing problem for the public as well as new practitioners. So, this kind of system
will help the users to choose which doctor to consult, maintain an online medical
record, get an appointment online and equal opportunity to all practitioners to be
reached by the public.

Because it is going to be the first-ever system of this kind in Pakistan, so it is very

important to keep the user interface very easy to understand and simple to use. So, I
tried not to bombard web pages with too much stuff.

Usually developing any system comprises of three basic steps planning, design, and the
testing phase. After finalizing the basic requirements that should be met by the system,
it was also important to decide which technologies to use for the development of this
system. For this purpose, I took help from the web and carefully studied already existed
similar web applications. Use case diagram, class diagram, and ER diagram are used to
better explain the system and its working. The purpose for drawing use case diagram
was to explain not only functionalities but also to write down the requirements of each
user very clearly. The class diagram was drawn to explain the relationship and behavior
of entities.

For now, I have chosen and working on some basic functionalities like an online
appointment, online database, and online doctor review. But for the future, I would like
to extend my system to the pharmacies and laboratories. For example, different
pharmacies and laboratories can also be registered with the system. And when the
doctor prescribes some medicine or writes some tests, the patient can just go to any
registered pharmacy and get the medicine after showing his ID. In the same way, if a
doctor writes some tests, the patient can go to any registered laboratory. Registered
pharmacies and laboratories would have some limited access to the patient data like
what is prescribed by the doctor and they can add the report result into the patient's
 40

database. Online follow up is another feature that I would like to add in my system at
some later stages. The idea of this feature came into my mind because the patients
living in faraway places have to come multiple times for the “laboratory test results”
and “doctors' advice/ follow-up appointment” based on those tests. So, after the
laboratory tests, patients just have to book an online time and they can have an online
conversation with some fewer fees. Online payment is again another feature I would
like to add at later stages.
 41

REFERENCES

Alex Chaffee (2000-08-17). "What is a web application (or "webapp")?". Retrieved

2008-07-27.

Bailey, N. (1952). A study of queues and appointment systems in hospital outpatient

departments, with special reference to waiting times. Journal of the Royal Statistical
Society, A14, 185-199.

Bailey, N. (1954). Queuing for medical care. Applied Statistics 3, 137-145

Cayirli, T, E. Veral, and H. Rosen. (2006). Designing appointment scheduling systems

for ambulatory care services. Health Care Management Science 9, 47–58.

Cayirli, T, E. Veral, and H. Rosen. (2004). Assessment of patient classification in

appointment systems. 1st Conference of the POMS College of Service Operations, New
York, NY, USA.

Fernandes C, Daya M, Barry S, Palmer N (1994). Emergency department Patients who

leave without seeing a Physician: The Toronto Hospital experience. Ann. Emer. Med.,
24: 1092-1096.

https://theseus.fi/bitstream/handle/10024/121504/Aljaf_Begard.pdf?sequence=1

Hypertext Mark-up Language, Introduction. Read 29.05.2016.

http://www.w3schools.com/html/html_intro.asp

Klassen, K. J., T. R. Rohleder. 2004. Outpatient appointment scheduling with urgent

clients in a dynamic, multi-period environment. Internat. J. Service Indust. Management
15(2) 167–186.

Koole, G., and G. Kaandorp. 2006. Optimal outpatient appointment scheduling,

Working Paper, Department of Mathematics, Vrije Universiteit Amsterdam, The
Netherlands, http://www.math.vu.nl/˜koole/articles/hcms07b/ (checked on May 24,
2007).
 42

James Duncan Davidson, Danny Coward (1999-12-17). Java Servlet Specification

("Specification") Version: 2.2 Final Release. Sun Microsystems. pp. 43–46. Retrieved
2008-07-27.

http://airccse.org/journal/jcsit/6414ijcsit05.pdf

JavaScript programming language, JS tutorial. Read 03.06.2016.

http://www.w3schools.com/js/

MySQL, Open source database. Read 05.06.2016.

https://dev.mysql.com/doc/refman/5.7/en/what-is-mysql.html
 43

APPENDICES

h 1:User Sign in/ up page

h 2:Patient's registration form