Intelligent Mobile Hospital Appointment Scheduling and Medicine Collection

Intelligent Mobile Hospital Appointment Scheduling and Medicine Collection Swabik Musa Abdulla Wani Computing and Information Systems Institut Teknologi Brunei Brunei Darussalam Alswabir012@gmail.com Abstract Proper patient Appointment Scheduling and Medication is necessary to manage and keep track of appointments and medicine collection. Normally, we see patients coming to the hospitals and health centers and filling out registration forms and waits for the response for an agreed date. The previous system did develop scheduling for hospital appointment which was purely dependent on nurse towards scheduling based on appointment received from patient by tapping NFC card on kiosk or from mobile. Also the hospital maintains database servers for appointment scheduling and medicine collection. The system however lacked intelligence in scheduling the appointment with doctors. In addition there were no timing constraints in place towards making or cancelling appointment. The system had no feature towards rescheduling or cancelling appointment too. In addition medicine collection used NFC card as cash card in deducting the money towards buying medicine and notifying the patient on mobile for collection. The system was designed only for Android based handset which was another drawback too. Last but not least there was no mobile feature for patients and doctors towards rescheduling appointment, looking for appointments and also receiving notification for appointment. So taking these aspects into consideration Intelligent Mobile Appointment scheduling and Medicine collection had been developed. The system however possesses the intelligence towards automatic calling of patient based on priority for appointment scheduling. Also system would enforce the timing constraints towards making, rescheduling and cancelling appointment. Last but not least the pharmacy side possess feature towards serving and declining medicine issuing for patients too in addition to sending notification on mobile for collection. The implementation been carried out using Php, MYSQL, HTML5, Dreamweaver CSS4 and 6, JQuery Index Terms NFC, Php, MySql, HTML5, CSS4. I. INTRODUCTION Appointment scheduling attracts increasing attention as the demand for healthcare increases. Due to the increasing number of patients visiting hospitals, there s a high demand for the introduction of intelligence and automation in respect of hospital related processes such as appointment scheduling and medicine collection. This is with a view to cub on the long waiting time [1][2], queuing for medicine Suresh Sankaranarayanan Computing and Information Systems Institut Teknologi Brunei Brunei Darussalam suresh.sn@itb.edu.bn and the complexity in hospital administration and this will increase the efficiency of medication/treatment and also increase patient satisfaction. Many techniques like online patient registration and appointment scheduling etc., have been developed [3][4] in order to improve on the workflow and to smoothen the waiting time but still these systems have got some constraints towards scheduling. There are two ways of getting the Medical consultation: one is Walk-in appointment and the other is scheduling an appointment. The call in the walk-in appointment will be received by an individual at the hospital who will store the appointment details and the request in either a large book or in a database. The appointments are then transferred manually to a general area, readable by all staff, or they are printed onto individual sheets of paper and distributed to specific specialists or doctors. The process repeats itself, sometimes multiple times every day. In the paper based appointment system and especially where the number of patients are high, there exists a greater possibility that some patient appointments will be updated without their notification. In addition to this, the act of updating/rescheduling appointments is tiresome and will be a thorough dissatisfaction towards a patient. The need for new ways towards providing more efficient health care services, coupled with the application of major advancements in Information and Communication Technology (ICT) have resulted in the increased use of ICT applications over the past decade [5]. Online registration and scheduling [4] of appointment has been one of the options for the healthcare administration to avoid the hassle of queuing and filling out registration forms. This has become inefficient as the transfer of patient s data can infiltrated online and hence the risk of online hacking. More to that, no prioritization facility is available for the online registered patients and so there is delay in entertaining them before they are called for consultation. Lastly there is no reminder system on any platforms. So towards obviating this defect with the use of mobile technology, an intelligent agent based Mobile patient appointment scheduling [6] was developed. This system allows patients to make appointment through the use of intelligent agents via the mobile. It may be mentioned that in this system the appointment scheduling 47 P a g e

has been carried out using intelligent agent on behalf of human being who also includes prioritization in respect of Senior citizen, physically challenged and so on. But still there exists some challenges like the absence of the reminder system for patients or doctors of upcoming appointment, etc. Secondly prioritized scheduling was facilitated for mobile appointments only and not for walkin cases, which again brings in a lot of waiting time and delay for patients. With this as basis, a Near Field communication (NFC) based appointment system [7][8] was developed where appointment received from patient by tapping the NFC card on kiosk for walk-in or from mobile. The system however lacks intelligence towards intelligent scheduling of patients which again was purely dependent on the nurse. Also system does not possess any automatic calling of patient and no confirmation of appointment done by patients from mobile when they come in. So based on the above drawbacks of the NFC based appointment system, we developed intelligent appointment scheduling [9] in the above NFC based system. With this, now the system here would incorporate prioritized scheduling based on appointment made by NFC thru walkin. In addition timing constraint been enforced towards making appointment and also system automatically prioritizes the appointments received. Lastly this system would call patient automatically based on prioritized listing of patient appointment for being served by the nurse. The intelligent appointment scheduling developed [9] been further enhanced in this research paper by adding mobile feature with intelligence towards Scheduling, rescheduling of appointment from patient and doctor side including cancelling for patient only. These feature been automated by software with no human intervention. In addition the notification feature for patient and doctor on their mobile handset been incorporated too. Lastly system does have feature of serving or cancelling of medicine to pharmacy in addition to sending notification for medicine collection. These been developed using CSS4, HTML5, and Dreamweaver to work on any mobile handset. The rest of paper is organized as follows. Section 2 provides the survey of literature on the subject area, and section 3 describes the Intelligent Mobile Hospital Appointment Scheduling and Medicine collection developed in this research. Section 4, provides the results of the research study carried out and section 5 provides the concluding remarks. II. LITERATURE SURVEY A. Paper Based Appointment System Paper-based system mostly requires patients to fill up the forms and submit to the registration desk or they could simply place their identification card or appointment card in the box provided and wait for their name to be called. The question is what happens if the card is misplaced or taken away by any unauthorized personnel? One issue that has been presented is that if patient s records are not to be found or declared as an unregistered patient, the current admission staff will delay his/her consultation time. Based on the survey report published in 2007 [10][11], most of the complained issues are on the time spent in the waiting room and in that 19% of the patients complained that they could not get an appointment within a week s time. Outpatient dissatisfaction with healthcare procedures was not only associated with waiting times but over one-third chose to not fulfill the appointment schedule as they expected to have to wait for long periods. This issue still remains a challenge in the healthcare industry worldwide. B. Online Appointment System Online registration and scheduling appointment has been one of the options next thought for the patients to avoid the hassle of queuing and filling out registration forms. It also inherently gives an advantage for the administrator towards monitoring and easy searching of any medical records or personal information as they are available online. However, it becomes inefficient as the transfer of data can be filtered as accessible online, and hence, the risk of online hacking has been very huge. In addition, even in the online registration and appointment scheduling, there has been no advancement in the technique towards providing any prioritization facility and so there is still a delay in entertaining patients before they are being called for outpatient consultation. Lastly there is no reminder system on any platforms for appointments which has been confirmed by the healthcare administrators [4]. BruHIMS (Brunei Health Information System) [12] has also made an attempt in acquiring the needs of healthcare management system by introducing an interactive scheduling for appointments and automatic transfer of prescription form from doctors to pharmacists. Moreover, the system also provides prioritization categories which are entered manually to the system. However, even though patient registrations are to be inserted onto a dedicated server, patient is still required to fill in a complex registration forms at the hospital. Appointment managements are still be made manually, whereby patients have to call to schedule an appointment. In addition, with the realization in using ICT in healthcare, outpatient staffs are able to access patient medical records, and making a quicker decision to lower the outpatient waiting times rate as it may reduce steps in procedures with consistent management. C. Mobile Appointment System Recently there has been a tremendous development in smart phones particularly in the hardware and software utilsed, which enabled the Mobile users through B3G (Beyond 3G) to roam freely through heterogeneous networks on all-ip platforms leading to implementation of Mobile health care [13]. 48 P a g e

Based on the above mentioned developments in mobile technology research was carried towards developing an intelligent agent based Hospital appointment scheduling [6] using Android Enabled Mobile handset. The System so developed eliminates the need of staffs in performing the similar tasks and admission activities which would eventually improve the speed of processing of any unscheduled appointment. The system takes into account the type of patient in prioritizing towards making appointment which is based on fuzzy rules and constraints. The system also possesses facility for seeing the list of appointments from doctor s handset and patient s handset. In addition, systems also possess facility for sending appointment confirmation. However, system application was inconclusive whereby there was no reminder sending possibility for patients or doctors towards the upcoming appointment. Also prioritized scheduling was suited for mobile patient appointment only and not for walk-in patients which again puts a lot of waiting time and delay for patients. So accordingly the Near Field Communication (NFC) based mobile appointment system was developed [7][8] where scheduling for hospital appointment and medicine collections were purely dependent on the nurse towards scheduling it from the system, based on appointment received from patient, by tapping the NFC card on kiosk or from mobile. This developed system however lacked intelligence usage towards prioritizing the appointment automatically and also no timing constraint towards making appointment. In addition no automatic call by the system based on list of scheduled appointment. So with this as basis NFC based intelligent appointment scheduling system [9] was developed which overcome above weakness. The system developed has been further enhanced by adding more intelligence and automation towards rescheduling, cancelling of appointment from doctor and patient side without need for human nurse at the hospital side. Lastly intelligence in sending notification to mobile user on their handset towards appointment, medicine collection and so forth. The details explained in forthcoming section. III. MOBILE INTELLIGENT HOSPITAL APPOINTMENT SCHEDULING SYSTEM Having discussed in detail about some of earlier appointment scheduling systems and their weaknesses, NFC based intelligent appointment scheduling system been developed [Suresh and Musa 2014]. The proposed system is an improvement over NFC based mobile appointment system [7][8] where patient taps the NFC appointment card on kiosk and then the appointment is made. The nurse on receiving the appointment prioritizes the patient based on age and disease type for doctor s consultation. The main weakness of the system, as mentioned, is that prioritization is not automated and is dependent on nurse only who prioritizes based on age and disease type. In addition no timing constraint is involved towards making appointment. All these motivated towards improving the NFC based appointment system by adding intelligence towards appointment scheduling. In the current NFC based intelligent appointment scheduling system developed [9], the patient on tapping NFC card at the appointment kiosk is provided with timing slot to make appointment which takes into consideration time at which card was tapped. A time window between 15 to 30 minutes is given for making appointment using kiosk and for patients confirming appointment made via mobile. We have made an assumption of minimum of 15 to maximum of 30 minutes time window for making an appointment. This assumption is based on fact that the system would then prioritize the patient list for nurse to view towards calling. Second improvement is the patient got the option to select the available doctors in the appointment slot while making appointment too. Thirdly once all appointments received, the system automatically prioritizes the appointments based on age and profile of each patient and not looking into disease type. In addition the system also allots the patient to the respective doctors for consultation too. Fourthly after the system prioritizes, list of patients and order in which they would be served is also displayed on LCD display system of the hospital. Now the prioritized patient list is accessible by the nurse towards automatic calling of patient towards payment before sending to the respective doctor allotted by the system for consultation. The doctor on the other hand gets the list of patients with their appointment id for consultation based on same prioritization. The current NFC based intelligent appointment scheduling developed [9] is been further enhanced by adding the mobile feature towards making appointment with intelligence where there might be patients who would want to make appointment from mobile but still confirmation of appointment need to be done by tapping NFC card at appointment kiosk 15-30 minutes before appointment slot. Secondly the system got intelligence towards rescheduling appointment from mobile for doctor side where system would automatically reschedule to next day as specified but still looking into schedule of other doctor s too. Similarly rescheduling and cancellation of appointment for patient from mobile is added too where intelligence exist in system towards rescheduling to same doctor or to any doctor again looking into doctor s schedule and so. Also patient is given provision to cancel appointment from mobile too. The need for nurse to reschedule or cancel appointment is completely removed unless in circumstances where patient after coming to hospital decides to reschedule or cancel it. In terms of medicine collection, system send automatic notification to patient s mobile for medicine collection towards due date. Similar notifications sent for upcoming 49 P a g e

appointments and so for doctor and patient s too. Lastly towards collecting medicine at pharmacist, in situations where patient does not turn up after calling for more than 3 times, a message sent to patient s mobile to collect medicine at any nearby pharmacy rather than coming again to the hospital for collecting too. This information sent to all pharmacists for enabling the patient to collect it without wasting much time. The architecture of Mobile Intelligent hospital appointment scheduling is shown in Fig.1. Fig.2 shows the Context diagram of the system. In the system all devices are connected to one local database, which contains: Patient lists from NFC reader device, including date and time the NFC Card come in contact. Patient basic information. List of confirmed appointments for nurses, doctors and pharmacists. List of new appointments, which have been entered by patients from mobile website application and from the Kiosk. Patient and health personnel s username and passwords. Context Diagram for NFC enabled Intelligent Hospital appointment Scheduling and Medicine collection PATIENT Appointment Scheduling Appointment Approval Notifications View Patients list for Diagnosis View confirmed Appointments NFC enabled Intelligent Hospital appointment Scheduling and Medicine collection NURSE View Appointment Information Incoming medical prescription Accepted appointment DOCTOR PHARMACY Fig.2 Context Diagram The Algorithm of system developed been described below towards scheduling, rescheduling & cancelling of appointment and medicine collection Fig.1 Architecture of Mobile Intelligent Hospital Appointment Scheduling Appointment Scheduling Step 1: Patient registers with hospital from mobile or as walk-in Step 2 : If registration successful, patient issued NFC appointment card. Step 3: Patient Taps NFC appointment card for making appointment either as walk-in/ mobile or from confirming appointment for those made via mobile. Step 4: Once details verified and authorized by tapping NFC card, patient be shown time slot available for appointment Step 4b: Patient allowed making appointment or confirming appointment up to maximum time window of 15 to 30 minutes Step4: If time window of 15 to 30 minutes is exceeded, patient cannot make/ confirm appointment for current time slot and has to make appointment in next available slot Step 5: Once time slot selected, patient has choice to select the preferred doctor too Step 6: Once all details selected, appointment sent to hospital server for recording Step 7: Once time window has expired, the hospital server would use the software intelligence in prioritizing the patients who made appointment based on their profile in the following order: 50 P a g e

Disabled Elderly Pregnant Infant Normal Step 8: Once prioritized, the patient serving order be displayed based on priority and nurse would call patient according to the order for being served and sent to doctor for consultation Step 9: Doctor after serving the patient according to prioritized listing are then sent to pharmacy for medicine collection Rescheduling Appointment- Patient side Step 1: Patient logs with NFC based appointment id and password from mobile Step2: On logging successfully, patient sends reschedule request like date, time, physician name if necessary. Steps 3: System on receiving reschedule request possesses the intelligence in rescheduling appointment of patient looking into doctor s schedule and availability. Step 4: Once successfully rescheduled, patient sent confirmation on reschedule to mobile handset. Cancelling Appointment- Patient side Step 1: Patient logs with NFC based appointment id and password from mobile Step2: On logging successfully, patient sends cancellation request Steps 3: System on receiving cancellation request cancels appointment. Step 4: Once successfully cancelled, patient sent confirmation on cancellation to mobile handset. Rescheduling Appointment- Doctor side Step 1: Doctor logs with id and password from mobile or computer Step2: On logging successfully, doctor can view the appointment towards reschedule Steps 3: On sending rescheduling request, System possesses the intelligence in rescheduling doctor appointment to next available date and time Step 4: Once successfully rescheduled, doctor and patient sent confirmation on reschedule to mobile handset Step 1: Patient after seeing doctor towards consultation sends the prescription with details electronically to pharmacist. Step 2: Pharmacist on receiving the prescription be called for collecting medicine by displaying the NFC id of patient on LCD panel in order in which prescription was received. Step 3: If patient for collecting medicine does not turn up after calling 3 times by pressing buzzer, the notification sent by system to patient mobile handset to collect in any pharmacy thru express counter than visiting the hospital again. Step 4: System also send automatic notification to patient mobile handset for regular collection of medicine say every 3 months or so. IV. IMPLEMENTATION OF MOBILE INTELLIGENT HOSPITAL APPOINTMENT SCHEDULING SYSTEM The implementation of Mobile Intelligent Hospital appointment scheduling system been carried out using MYSQL with WAMP server and PHP. The database system is developed using MySQL which is an open source application owned and managed by Sun Microsystems and acquired by the Oracle Cooperation. The web side scripting been carried out using PHP, a popular general purpose scripting language.cs6 used for mobile side development to be compatible with all mobile handsets. In our implementation NFC device was simulated and not real hardware was used. The primary reason is that there already exists a NFC based Mobile appointment system [7][8] where the NFC reader was interfaced with hospital appointment database to make appointment. The system however lacked facility for patient to see list of appointment slots to choose and no automatic prioritization. So with that as basis we here have simulated NFC side as our research more towards intelligent appointment scheduling based on previous system rather than building NFC based Mobile appointment system again. Let us consider hospital appointment scheduling scenario for walk-in patient appointment. Now before making appointment, walk-in patient got to be registered which nurse does as shown in Fig.3 Medicine Collection- Pharmacist side 51 P a g e

Fig.4 NFC Tapping and Appointment Time slots Fig.3 Patient Registration- Walk-in Patient Once patient registered successfully, patient is issued with NFC based appointment id. Now towards making appointment for walk-in patient, patient taps the NFC enabled appointment id in the NFC based kiosk as shown in Fig.4. Once appointment card is tapped, appointment kiosk will show the respective time slots which takes into account the time at which card was tapped. In here we impose a constraint towards making appointment which is 30 minutes and failing which next available appointment slot is shown as shown in Fig.4. Once time slot is selected, the available doctors shown for selection which is optional anyway as shown in Fig.5. Fig.6 shows appointment confirmed with appointment details sent to Hospital server. In this system if patient past 15 to 30 minute constraint, patient cannot make appointment. In Fig.7, we see that patient past 15 to 30 minute constraint for 8:30-12:00 p.m time slot and so accordingly patient can make appointment for next time slot available only which is 2:00-4:00 p.m. Fig.5 Doctor Selection 52 P a g e

Fig. 6 Appointment Confirmation Fig.8 Prioritized Patient Listing Once patients prioritized, patients sitting will be notified the sequence in which patients going to be called on the LCD Display system. We assume here that there would be most probably 3 to 4 nurses operating towards calling patient to take payment before sending to doctor. So accordingly nurse would select the patient 1 from prioritized listing and accordingly system would show the appointment id of patient being served on the counter as shown in Fig.9. Once the first patient selected, the other nurse counter would see the remaining patients only for serving and not the one being served. In here you see Patient appointment id 220 i.e Edward is being called by counter 04 nurse for serving and next nurse counter nurses would see remaining patients as shown in Fig.10. Fig.7 Appointment Slot Closed In here we take as case five patients who are making appointment for 8:30 a.m -12:00 noon time slot as shown in Fig.3. We here have patients with varied profiles like Disabled, Senior citizen, Pregnant, Infants and Normal patient who making appointment using NFC appointment card at kiosk. The software based appointment system accepts all appointment up until 30 minutes before the start of appointment time slot and failing which next appointment slot shown. Once all appointments received, software based appointment system possess the intelligence towards prioritizing all appointment received by pulling the profile of registered patients from database and accordingly prioritized in the order as Disabled, Senior Citizen, Pregnant, Infants, Normal patient which is shown in Fig. 8. The prioritized patient listing is available on nurse computer to call the patient now. Fig. 9 Appointment Id with Counter- LCD display 53 P a g e

Fig.10 Patient Listing for Serving- Nurse Side Now before patients served by nurse, prioritized patient listing sent to doctors on duty towards medical consultation. The software here possess intelligence towards forming combination of prioritized & normal patient listing to each doctor on duty once appointment made from NFC kiosk so the order in which patients served are according to same priority only as in nurse side and accordingly waiting time reduced. In addition against each doctor office the order in which prioritized patients with appointment id going to be called is displayed. This information sent to doctor system too. But the doctor gets clearance for calling the patient once served by nurse and payment made. This doctor sees in his system against the patient as Serve being activated as shown in Fig.11. On clicking Serve, patients see the appointment id flashed on LCD display system against doctor office for meeting. ISSN: 2312-7694 Fig.12 Doctor interface- Medical Consultation Fig.13 Patient Serving- Pharmacist side Fig.11 Patient for Serving- Doctor Side On serving the patients, doctor would get an interface for recording the medical history and prescription for pharmacy for issuing medicine to patient too as shown in Fig.12. These details recorded against Patient profile in database. At Pharmacist side, patient details sent along with appointment id for serving as First come First serve basis once doctor consulation over and details recorded in database. So accordingly patient appointment id diplayed on LCD for collecting medicine by pressing serve button by pharmacist as shown in Fig. 13. In addition to making appointment, medical consultation and medicine collection for walk-in patient, the software here possess the interface for nurse towards rescheduling appointment for patient on request by doctor or by patient itself as shown in Fig.14. Lastly the system also got interface towards scheduling duty roster for nurses, doctors and pharmacist as shown in Fig.15 by the administrator or by nurse as appropriate. In addition, nurse and doctor can view patient medical history too from the system. 54 P a g e

appointment day as shown in Fig.4 with timing constraint of 15 to 30 minutes before appointment time slot. Fig.14 Reschedule Patient Appointment- Nurse Interface Fig.16 Mobile Patient- Logging Fig.15 Scheduling Duty Roster We have seen so far for walk-in patient appointment and would see in forthcoming section on how patient can make appointment from mobile and so forth. Let us consider a situation where patient wants to make appointment from mobile rather than walk-in to hospital. In such situation, registered patient logs into mobile using NFC id as user name and password as shown in Fig.16. Once registered successfully, patient can make appointment as shown in Fig.17 by specifying date, time and name of physician too. Once all details given, the mobile handset interacts with software of hospital towards making appointment by giving appointment id as shown in Fig.18. But still patient needs to confirm the appointment using NFC ID in NFC Kiosk of hospital on the Fig.17 Mobile Patient Appointment Fig.18 Appointment ID Confirmation In addition to making appointment, patient also from mobile towards receiving notification on mobile handset like upcoming appointment, collection of medicine from pharmacy as shown in Fig.19. 55 P a g e

Fig.21 Appointment Rescheduled Fig.19 Notifications on Mobile- Patient side Lastly patient on his mobile handset receive notification from pharmacy to collect medicine in addition to upcoming notification. This notification from pharmacy is for two scenarios- One scenario for regular medicine collection. The second scenario is where patient after medical consultation, their prescription details sent to pharmacy for collection. On calling the patient three times for collecting medicine if patient does not turn up, system automatically send notification to patient mobile to collect in any pharmacy as shown in Fig.23 and this information sent to other pharmacy of hospital too. In addition Patient also can reschedule appointment from mobile too. Fig.20 shows the list of appointment on mobile for patient. On selecting the appropriate appointment id, patient is given the option to reschedule the appointment to next convenient date as shown in Fig.20. These details sent to software of hospital scheduling system which got intelligence to look if there are free slots available for rescheduling appointment to next available date and time. If slots available, appointment rescheduled and information sent to mobile handset with appointment id as shown in Fig.21. Fig.23 Collection of Medicine Notification- Patient Mobile We see now as how doctor from mobile handset can reschedule appointments and also incoming appointments through software without having nurse to do it for doctor. In terms of incoming appointments and reschedule of appointment, doctors logs into system with their username and password. Once logged successfully, doctor view the incoming appointments as shown in Fig. 24. Fig.20 Patient Appointment- Reschedule from Mobile 56 P a g e

Fig.24 Incoming appointment- Doctor Mobile In terms of reschedule appointment, doctor view their appointment and accordingly got option to reschedule as shown in Fig.25. On reschedule, the details sent to software scheduling system of hospital which looks into available free dates and time by referring to duty roster of other doctors for rescheduling appointment as shown in Fig. 26. Once rescheduled, the notification sent to patient s mobile too. Fig.25 Rescheduling Appointment- Doctor Mobile Intelligent Agent towards patient appointment using Android mobile handset which uses fuzzy preferences for appointment scheduling. Also there has been work on BruHIMS by Government of Brunei on Electronic medical record which has been further improvised by developing NFC based patient appointment system. These two were motivation toward our Intelligent Mobile Hospital Appointment Scheduling and Medicine Collection system which is believed to improve the performance focusing on the critical component. It is proven that those technologies can be used to replace manual and traditional systems in appointment scheduling and outpatient records. This system will centralize scheduling system and sorting the prioritization. The architecture of developed system been presented followed by Algorithm and technologies used in this solution presented as screenshots. In Future, the system could be further enhanced by intelligently scheduling for normal patient thereby still more reducing waiting time. Secondly system could also check the availability of medicine before calling patient for collection and so forth. Also the system can also have feature towards electronically authorising towards collection medicine in any other hospital if medicine not available in current clinic or hospital. The system can be made cloud enabled which enables storing the appointment, medicine and health record details in distributed cloud server than centralised cloud server. Last but not least system can also be extended to look into Quality of service and security issues in cloud while storing patient appointment and medicine details. REFERENCES Fig.26 Rescheduled Appointment Confirmation V. CONCLUSION & FUTURE WORK So to conclude, the research work in hospital scheduling system presented face some of the challenges that currently patient and staff alike were poorly executed and inefficient scheduling systems are concerned. For refining the core operations in outpatient clinics in respect of health applications, paper-based methods were used which resulted in low quality and efficiency as well as longer waiting times for both scheduled and walk-in patients. With the advent of ICT, lot of online appointment scheduling system has been developed but still faces some challenges. There has also been work reported on using [1.] R. B Fetter and J. D Thompson, Patient s Waiting Time and Doctors Idle Time in the Outpatient Setting. Health Service Research, Vol.1, pp. 66-90, 1996. [2.] E. P Fung, Patient Waiting Time for General Cases at Bandar Seri Begawan Health Centre. Brunei International Medical Journal, Vol.9, pp. 366-371, 2013. [3.] P. R Harper, P. R and H. M. Gamlin H. M, Reduced Outpatient Waiting Time with Improved Appointment Scheduling: A Simulation Modelling Approach. OR Spectrum, Vol. 25, pp.207-222, 2003. [4.] C. Wenjun et al, A web-based appointment system to reduce waiting for outpatients: A retrospective Study, 2011, Available from http://www.biomedcentral.com/1472-6963/11/318 [5.] WHO. (2005). Information Technology in Support of Health Care. Available: from http://www.who.int/eht/en/informationtech.pdf 57 P a g e

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