problems faced by hospital appointment reservation system

timer Asked: Nov 25th, 2016

Question description

Case #1: Hospital Appointment Reservation System

Lamptey Memorial Hospital is a distinguished medical group practice of approximately 100 doctors and it is located in a major urban area. Its primary service is an "out-patient" or ambulatory practice which is, in effect, a collection of doctors' offices together with the necessary facilities to perform medical tests such as x-rays and chemical analysis of body fluids.

The area to be investigated at the hospital was that of reserving time for patients. This function is primarily performed by a department called the Central Appointment Office.

In the Central Appointment Office, a group of 25 secretaries schedules appointments for the hospital's physicians and for a few major medical tests. Each doctor's available time, divided into 15-minute periods, is shown on a card for each day—with the cards for the next three months available to the appointment personnel at any one time.

Depending on the circumstances of a patient's appointment request, an appointment secretary decides to which physicians and for which tests the patient should be scheduled. An attempt is made to schedule patients as fully as possible to all physicians whom the secretaries believe the patient should see. The choice of departments and doctors for which a patient is scheduled is dictated by a set of rules developed by hospital medical management.

The scheduling of tests by the Central Appointment Office (CAO) is quite limited. In general, the CAO schedules only a half dozen, major, time-consuming tests, such as electrocardiograms, electroencephalograms, and intravenous pyelograms. The scheduling of doctors is, however, extensive. The CAO's task is more difficult than merely to schedule patients to the correct one or more of the 12 major departments (e.g., general surgery, neurosurgery, urology, internal medicine, etc.). An attempt is also made to schedule the patient to the appropriate sub-specialty within a department (for Instance within internal medicine, to sub-specialties such as cardiac, vascular, etc.). Furthermore, an effort is made to steer specific patients to particular physician sub-sub-specialists who are interested and expert in one disease or particular area (i.e., diabetes, liver malfunction, etc.).

In all cases, the appointment secretary must select from an inventory of available doctor and test time a feasible and hopefully optimal series of appointments for a patient. The hospital's management originally viewed the process as akin to the airlines reservation process, and the initial charge to the systems effort was in these terms.

Business rules

The business rules for patients’ scheduling are as follows:

1. If a patient desires a complete medical examination, no attempt whatsoever is made by the schedulers to determine the patient's condition for scheduling purposes. The patient is merely given the first opening available for a physical examination with any member of the staff who performs complete physical examinations.

2. No attempt is made by the clerical scheduling personnel to develop a full routing for the patient. Only the first appointment is scheduled in the manner noted above.

3. Appointment time length is standardized. In most cases, complete physical examinations are assumed to take one hour. All other appointments are assumed to take 15 minutes.

Given the above rules, therefore, the patient arrives at the hospital scheduled to see an initial physician. The remainder of the routing is performed by the first doctor whom the patient sees. The routing is done only after the patient has been given a complete physical examination by the doctor. As a result, the doctor is the scheduler. And the scheduling is done on the day that the patient arrives at the hospital. Since there is no need for one group of secretaries to have access to all the appointment cards (so that they can pre schedule patients to all necessary physicians), most appointment cards are kept in each physician's location—on a decentralized basis.

The Problem

Each patient who enters the hospital’s facilities represents a unique problem and has a need to see a particular set of specialists and to utilize a specific set of test facilities. The problems of determining exactly which physicians and major tests should be scheduled, and in which order these should be scheduled, appears to be a relatively impossible task for a group of lay secretaries many without any medical experience whatsoever. Yet the secretaries were seen to make both the facility (doctor and/or tests) and ordering choices to build a schedule for each patient. The schedule should be "optimal" in terms of choosing the correct doctors and tests while also minimizing the patient's time spent at the Medic Center in the diagnostic process.

In making these choices, the appointment secretaries were seen to face a major dilemma which can be summarized as follows: On the one hand, if the secretary schedules the patient to see more doctors than he requires, there is a high probability that the first doctor to see the patient will cancel the excess appointments; and that the suddenly released (and therefore available doctor time) will not be used by other patients. There is no backlog of patients waiting to be moved up automatically in the queue for a doctor if another patient's appointment is cancelled.

On the other horn of the dilemma, if the patient is scheduled to see fewer doctors than necessary, it is quite possible that the additional doctors for whom the patient should have been scheduled will be booked completely on the day the patient enters the hospital. This may place a heavy burden on the patient. If the patient is from out of town, he may have to extend his stay in a hotel. If he is a local patient, he may have to make another trip to the hospital.


1.  Identify and explain fifteen problems confronting the current Hospital Appointments Reservation System. [30 marks]

  1. Construct activity diagrams, use-case diagrams, sequence diagrams, class diagrams, and object diagrams for the Hospital Appointments Reservation System.  [30 marks each = 150 marks]

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