2017 5th International Conference on Electrical, Electronics and Information Engineering (ICEEIE)
Queue Model in Health Facilities Information System
Agung Nugroho Pramudhita
Department of Information Technology, Faculty of Science and Technology
Universitas Islam Negeri Maulana Malik Ibrahim Malang
Malang, Indonesia
agung.pramudhita@gmail.com
system by using queue cards/books, whereas in the
conventional queuing system, injustice queue is possible [3].
Abstract—In many health facilities, patients wait for long time
before they are attended to by the health personnel. This trend is
increasing and it is a potential threat to healthcare services. In
Indonesia, health facilities with large number of patients such as
general hospital, private clinic, private hospital, and community
health centre have cases where patients may not be serviced on
time while others may end up going home without receiving
medical services. In this paper, an efficient queuing model for
proper queueing system is proposed as the solution to the long
waiting times in these health facilities. From those problems, we
need a technology to facilitate patient in doing the queue. In this
research, queue theories are studied, and a queue application as a
web application is designed. The user of queue application is
divided into two sides, the patients who register and queue and
the operator who manage the patient data and queue data. The
output of this application is to make the queue system that can be
done online in every department in health facilities, the patients
queue data is displayed in screens so that the patients could know
who is being treated and how may people left before the patient is
called. A notification feature also provided so that when a queue
number is called the patients received a notification to soon be
able to return to the location of the doctor. The application is
designed as a module so that it can be integrated with other
module in Health Information System for future research. By
Implementing such system hopefully service effectiveness and
efficiency will be improved and patients’ satisfaction can be
increased
Information, data, and communication technology today
has grown rapidly in line with the development of the
characteristics of modern society that has a high mobility, look
for a service that is flexible, convenient, satisfying as well as
effective and efficient in all aspects of life. Based on the facts
that occurred in the community at this time, it should have been
used as the material for evaluation and consideration in order to
establish a system or technology as required by society, with
many references that exist today, it can be used to exact
formula and create the appropriate and sustainable system or
technologies. This prompted the authors to do research by
developing a web-based queuing system in health facilities.
The problems formulation in this research is on how to
make a queue system controlled by a computer program so that
it reduces the work load of health facilities employee. And also
by the existence of computerized queuing system the queues in
health facilities could run smoothly without any problems. The
objective of this study was to design a queue system at a health
facility in global nature and enable to be used in other queue
cases.
QUEUE THEORY
Queues are a common occurrence in our daily lives.
Waiting in front of the booth to get a train ticket or a movie
ticket, at the door of the toll road, at the bank, the cashier at the
supermarket, and other situations are often encountered
occurrences. Queues arise due to the demand for services
exceeds the services ability (capacity) or services facilities, so
that users of the facility that arrived could not immediately get
the service due to the busyness of service. In many cases,
additional service facilities may be given to reduce the queue
or to prevent queues. However, the cost to provide additional
services will lead to a reduction in profits. On the contrary, the
frequent occurrence of long queues will result in the loss of
customers/clients. In designing queueing systems, we need to
aim for a balance between service to customers (short queues
implying many servers) and economic considerations (not too
many servers).
Keywords—queue system; web application; Health facilities
INTRODUCTION
Nowadays, there are many agencies/companies that do not
use technology to provide convenience for customers. Public
awareness about the order and discipline is still far from
perfect. Queues are widely applied in the agency/company
such as health facilities (hospitals, clinics, and doctors' offices)
that have a lot of patients. Many patients feel that they are not
getting good service because of the queuing system that still
conventional and disorderly [1].
Basically, queuing to get any service is unfavorable,
especially when in need of health services. Health services are
very difficult to determine the traffic, because we do not know
when the people are sick. This greatly affects duration of the
queues at health facilities. By variation of the patient's arrival at
the service, it will affect the performance and efficiency of the
medical personnel or the workforce, and affects the patients’
satisfaction and comfort [2]. There are still many Health
facilities which are still using conventional (manual) queuing
978-1-5386-0355-0/17/$31.00 ©2017 IEEE
The first ever queuing theory was developed by a Danish
telecommunication engineer, Agner Krarup Erlang. He also
analyzed a single facility queues called Erlang mathematical
model where arrivals of customers are based on a Poisson
process [4]. Erlang's model inspires mathematicians, scientist,
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2017 5th International Conference on Electrical, Electronics and Information Engineering (ICEEIE)
engineers, and Computer Scientist to deal with problems using
queuing theory and gave an explicit insight of an additional
quality of service to limit waiting times especially in the queue.
waiter choose the customer in accordance with the service
discipline, and ultimately the customer leaves the queuing
system after completion services (Fig. 1).
Another important determinant is the queue queuing
discipline. Queuing discipline is a decision rule that describes
how to serve customer, there are four forms of commonly used
queuing disciplines, namely:
QUEUE COMPONENTS
A. Arrivals
Every queue problem involves arrival process such as a
person, a car, a phone call to be served, and others. This
element is often called the input process. Input process includes
the source of arrival or commonly called calling population. If
the occurrence of arrivals and the offer of service proceed
strictly according to schedule, a queue can be avoided. But in
practice this does not happen [5]. In most cases the arrivals are
a product of external factors. Therefore, the best one can do is
to describe the input process in terms of random variables that
can represent either the number arriving during a time interval
or the time interval between successive arrivals [5]. If
customers arrive in groups, their size can be a random variable
as well. According to Levin, et al [6], a random variable is a
variable whose value can be any amount as a result of the
randomized trials. A random variable can be either discrete or
continuous. If the random variable only has some possible
value, it is a discrete random variable. In the contrary, if the
possible value varies in a certain range, it is known as
continuous random variables. Typically, the arrival is described
by a random distribution of intervals also called Arrival
Pattern.
1.
FirstCome FirstServed (FCFS) or FirstIn FirstOut
(FIFO) Means that the customers who first came (in),
is the first served (out).
2.
LastCome FirstServed (LCFS) or LastIn FirstOut
(LIFO) Means that the customers who last came (in), is
the first served (out).
3.
Service in Random Order (SIRO) means that the
customers are served in a random order with no regard
to arrival order.that customers who first came (in), is
the first served (out).
4.
Priority Service (PS) Priority Service (PS) means the
service priority given to the customer that has a higher
priority than customers who have a lower priority,
although the latter is possibly the earliest to arrive in
the waiting line. Such an event may be caused by
several things, such as someone who is in a state of
more severe disease compared with others in an ER.
C. Server
Server or service mechanism can consist of one or more
servers, or one or more service facilities. Each service facilities
are sometimes referred to as a channel [7]. Here is where the
customers get the service needed after the queueing process.
B. Queue System
The queuing system is the arrival of customers to get the
service, waiting to be served if service facilities (server) is still
busy, get service and then leave the system after being served
[7]. According to Bronson [8], the queue process is a process
associated with the arrival of a customer at a service facility,
waiting for a call in the queue lines if you have not got a
service and eventually leave the facility after receiving
services.
QUEUE MODELS
There are 4 basic queuing models which are commonly
occur in the queuing system [7]:
1) Single Chanel - Single Phase
Single Channel mean there is only one path that enters the
system or service facilities. Single Phase means there is only
one service facility (Fig. 2). So in other words, among the first
to take a queue number is the first to be served, whereas the
last who takes the queue number will also be served last. the
example is a supermarket that has only one cashier as the place
of payment.
The very long queues and too much time to obtain turn
services will make customers uncomfortable. The average
length of waiting time is dependent upon the rate of services.
The emergence of queues, especially depending on the nature
of the arrival and service processes, if there is no queue means
that there are waiters who are idle or excess of service facility
[7].
Fig. 2. Single channel – single phase queueing model
2) Single Chanel - Multi Phase
Single lane queuing system with multiple stages or there
are two or more services which executed sequentially (Fig. 3).
For example: queuing in car wash services.
Fig. 1. Queueing System
Based on description above, the queue process begins when
customers who need the service started coming. They come
from a population that is referred to as the input source. The
queue process is a process associated with the arrival of the
customer to a queue system, then wait in a queue until the
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2017 5th International Conference on Electrical, Electronics and Information Engineering (ICEEIE)
facilities. Deep sense of disappointment, frustration, and
dissatisfaction with service personnel in Health facilities often
experienced by patients and their families because the received
services are so long and seems slow.
Fig. 3. Single channel – multi phase queueing model
Disappointment related to the long and slow service cannot
be denied would be much higher if the patient tries to get
service in government hospitals, both at the local and central
government. Though the quality of medical and nursing
services provided by the government hospitals is not better
when compared to other private hospitals. Perceptions of slow
and long service by patients and their families will greatly
affect the overall level of satisfaction with the services
provided by the hospital. When the patient perceives the
service received is slow and long, then the overall patient
satisfaction with the services provided by the hospital will
decrease.
3) Multi Chanel - Single Phase
Multi-Channel - Single Phase System occur where there are
two or more service facilities with a single queue line (Fig. 4).
An example is a queue at the bank with several tellers.
Currently applied queue and processes management
systems could be the cause of slow and long service in the
health facilities. So it is important for the health facilities to
look seriously and analyze the process flow of its service if it
wants to improve the service waiting time. Starting from the
stage before registration to discharge. the Health facilities need
to identify the steps that need to be improved in order to reduce
and even eliminate the slow and long impression.
Fig. 4. Multi channel – single phase queueing model
4) Multi Chanel - Multi Phase
Multi-Channel - Multi Phase System indicates that a system
has several service facilities at every stage so that there is more
than one customer can be served at the same time (Fig. 5).
Examples of this model is the service provided to patients in
hospitals starting from registration, diagnosis, medical
treatment, until payment.
B. Information System Integration in Queue and Process
System in Health Facilities
The use of information system, besides useful to quicken
the delivery of information, information systems in the form of
patient medical records and patient registration software /
queue applications can make the process of service performed
simultaneously and not repetitive. For example, when a patient
has registered, medical record data can simultaneously be
received at the clinic, and even proceed to the pharmacy or
administration section when the patient had been served by the
doctor. Repeated registration recording, manual/paper-based
prescription or medical records is not required. with such a
system, the whole process in health facilities can be more
effective and safer. Overall waiting times within each point of
the service stages can be reduced significantly.
Fig. 5. Multi channel – multi phase queueing model
HEALTH FACILITIES
Definition of health facilities are all the facilities and
infrastructure that could support our health, both physical
health and spiritual health. According to the presidential decree
[9], stated that the definition of health facilities are health care
facilities that are used for organizing individual health care
efforts, which are promotive, preventive, curative and
rehabilitative that conducted by the government, local
government, and / or community. So, health facilities can be in
form of hospitals, community health centers (puskesmas),
doctor clinics, and private clinics. The public will be more
enthusiastic in maintaining health when there are many
supporting facilities. The health facilities are available from the
cheapest to most expensive and from the simple (readily
available) too difficult to obtain.
Moreover, by including queue monitoring system in patient
registration software, after the patient registered, he got the
queue number and he can see directly which number is being
served and how many patients left before he receives medical
service. By knowing that information, the slow and long
impression can be reduced. If the patient can predict the time
for his service, the patient could do something else or go
somewhere else while waiting.
WEB APLICATION
In order to simplify the software development and software
implementation process in any health facilities and in the same
time making sure that the developed software can be used in
most desktop computer or laptop and mobile devices that exist
in health facilities the researcher designed the software as a
web application. By using web application, it does not require
complicated installation in every pc that will be used.
A. Queues in Health facilities in Indonesia
Like it or not a time will come for the person to experience
ill and need the help of health services in the form of
medication or treatment in order to recover from his illness. It's
Become normal for patients to have to wait quite a while
before getting services from doctors or staff in the Health
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2017 5th International Conference on Electrical, Electronics and Information Engineering (ICEEIE)
Fig. 6. how web app works (Source: https://www.maxcdn.com/one/visual-glossary/web-application/)
In computing, a web application or web app is a client–
server software application in which the client (or user
interface) runs in a web browser [10] See Fig. 6. Web
applications are usually coded in browser-supported language
such as JavaScript and HTML as these languages rely on the
browser to render the program executable. Some of the
applications are dynamic, requiring server-side processing.
Others are completely static with no processing required at the
server. The web application requires a web server to manage
requests from the client, an application server to perform the
tasks requested, and, sometimes, a database to store the
information. Application server technology ranges from
ASP.NET, ASP and ColdFusion, to PHP and JSP.
percentage of hospital employees and 90% of patients the
hospital said the queuing system is helpful.
Haryanto, [3] has created a web-based application queuing
system that allows the administrator does not need to call
queue number manually, simply operate the queue call
application. In a queue system application that is created does
not handle queued number calls that have been passed. So
patients who missed the queue sequence number must print a
new ticket queue. The video display is also provided on the
display page.
All of the researchers mentioned above developed a queue
application with only queue number without patient’s name on
its display, so it will be hard on patient if he loses or forgot the
queue number. Those queue applications are also standalone
queue application; it is not integrated in the health facilities
information system. Therefore, it is harder if the health
facilities want to develop and use another application in their
facilities such as medical records or pharmacy application. The
queue application/patient registration application that will be
developed is designed as a module to be easily integrated with
integrated health facilities information system. It will be
developed by using 9 integrated modules: (1)
registration/queue, (2) patient medical records, (3) polyclinic,
(4) inpatient, (5) outpatient, (6) emergency room, (7)
pharmacy, (8) inventory, and (9) automatic health facility
reports. The reason of using 9 modules is because they
represent the services needed by patients, doctors, nurses, and
other health facilities employee. So, by utilizing this integrated
health facilities information system, the service effectiveness
and efficiency will be improved and then lead to increasing
patients’ satisfaction level.
Usually web application works in this sequence:
1.
User triggers a request to the web server over the
Internet, either through a web browser or the
application’s user interface
2.
Web server forwards this request to the appropriate
web application server
3.
Web application server performs the requested task –
such as querying the database or processing the data –
then generates the results of the requested data
4.
Web application server sends results to the web server
with the requested information or processed data
5.
Web server responds back to the client with the
requested information that then appears on the user’s
display
STATE OF THE ART
Aziz, Riza, and Tulloh, [11] have designed a queue
applications based on Android and SMS Gateway. The output
of this queue system application is to make the queue process
that provides a notification feature so that when the nearest
queue number called the patient to get a reminder in the form
of a notification on android or SMS to immediately return to
the location of the doctor.
RESEARCH METHOD
A. Literature review and observation
The author searches the literature for information related to
queuing issues in daily life and procedures in obtaining
services at health facilities through books, previous scientific
works and observations at health facilities.
Fridatama, N, Budikarso, A., Yuliana, M. [1] has created a
queuing system using java programming language, where the
system that is made including the registration system, queue
number printing machine, queuing machine, and sms gateway.
The created queuing system has been successful, the average
execution time required for registration is 51.16 seconds and
the average time required for server connection to the printer is
1 minute 27.47 seconds. The results of a survey on hospital
workers and hospital patients can be said that the JAVA-based
queues system on hospitals have an assessment result as
helpful categories, judging from the results of 85% the
B. Application Development
Application development method used in this research is
Waterfall method, which covers requirement analysis stage,
Requirement specification, system design, Development,
integration & testing, Deployment [12].
1) Analysis and Requirement Specification
At this stage the related data will be collected to specify the
requirements in making the application.
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2017 5th International Conference on Electrical, Electronics and Information Engineering (ICEEIE)
(i.e. general practice, dental, dermatology, cardiology, etc.). To
use the application, first patient must register at the reception,
the operator will check if the patient is old patient or new
patient, if he is a new patient then the operator will ask about
the data regarding the patient (name, address, phone,
illness/symptoms, etc.) the record it’s data, if the patient is old
patient the operator will ask about its current illness/symptom’s
and record the data. After the data is recorded it will be sent to
local server and the patient will get queue number. In the local
server the patient data will be synchronized with the data in
hosting server as backup and sent to operator at the appropriate
department according to the patient illness/symptom’s. After
the data arrived at the department’s operator, the queue number
and the patients name will automatically be displayed in the
queue display. When is the time for the patient to receive
service from the doctor’s office then the operator will call the
patient and notify in the queue display. For the detailed
diagram scheme see Fig. 7.
2) Design
This stage is done before coding. This stage aims to give an
idea of what should be done and how it looks. This stage helps
in specifying the hardware and system requirements and
defines the overall system architecture. At this stage done the
analysis and design required in making the system, including
the design of Data Flow Diagrams, Use Case Diagrams,
databases, and user interfaces.
3) Development
In this stage, the programming or coding is done. The
software is broken down into small modules which will be
incorporated into the next phase. Also in this stage examination
of modules is also done, whether it has fulfilled the desired
function or not. Coding is made with the help of PHP
programming language editor program.
4) Integration and Testing
At this stage, modules that have been made are
incorporated and the developer determine whether the software
is created in accordance with the design and to detect the
presence of error testing is performed.
INTERFACE DESIGN
The interface in the queue web application designed in such
a way so that it is easier to be used by the operator, and in
Indonesian language because it will be deployed in health
facilities in Indonesia. The queue system consist of web pages;
those web pages are as follows:
5) Implementation / Deployment
This is the last stage in the waterfall model. The finished
software is ready to be implemented in health facilities.
A. Registration page
This registration page (Fig. 8) is the web pages used when
the patient register himself. The operator could search for the
old patient or add new patient, open the patient data, and
register the patient. The operator can search the old patient
based on the citizen’s identification number (KTP/ Kartu
Tanda Penduduk), member id, patient’s name or the patient’s
fingerprint. After the search the list of old patients that match
the search terms are displayed, if the concerned patient name is
not present, the operator can add new patient. After the
operator register the patient, the patient registration page will
open.
At this study, the application development method will be
done until the design stage. The rest of the stage will be done
on the future research.
QUEUE SYSTEM DESIGN
The main problem solved through this queue system is the
queue number retrieval by the patient and the waiting time of
the queue that was initially unpredictable becomes known to
the patient. The queue system will be implemented in health
facility which has one or more departments (excluding the ER
department) and more than one type of services, therefore,
multi-channel - multi-phase queue model with First Come First
Served algorithm is used. This queue system consists of Web
application, pc and screen to display queuing sequences, printer
to print the queue number and speakers to call queue numbers.
B. patient registration page
In this patient registration page (Fig. 8.) operator could
view some of patient’s data and chose the type of health
insurance if the patient has it, choose the type of service that
will be given to the patient (general practice department,
dentist department, laboratory, etc.) and finally register the
patient to corresponding department.
In the implementation of the queue application, it is
implemented in one health facility and divided into 2 subsystem, which are reception and departments at health facilities
Fig. 7. Queue Application Implementation Scheme
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2017 5th International Conference on Electrical, Electronics and Information Engineering (ICEEIE)
integrated with other module which later become integrated
health facilities information system consist of (1)
registration/queue, (2) patient medical records, (3) polyclinic,
(4) inpatient, (5) outpatient, (6) emergency room, (7)
pharmacy, (8) inventory, and (9) automatic health facility
reports. By using this integrated health facilities information
system, the service effectiveness and efficiency will be
improved and patients’ satisfaction can be increased.
Fig. 8. Registration Page
REFERENCES
[1]
[2]
[3]
Fig. 9. Patient Registration Page
C. Patient queue pages
In this patient queue pages consist of two page, one in
display screen that can be seen by the patients (Fig. 9) and one
in the PC/Tablet of the operator (Fig. 10). In patient queue
page, the patient can see the type of service/department, time
and date, total number of waiting patient, patient being
serviced, and patients queue data.
[4]
[5]
[6]
[7]
[8]
[9]
Fig. 10. Patient Queue Page
[10]
[11]
[12]
[13]
Fig. 11. Patient Queue Page
In the operator queue page, the operator can see the number
of queue, time, and the queue data. The operator can call the
queue number when is the time for the patient to receive
medical service.
CONCLUSION AND FUTURE RESEARCH
The problems in queue system in health facilities can be
solved if the queueing theory is understood and implemented.
The health facilities commonly have some department and
various services, so the queueing model that match those
criteria is multi-channel multi-phase, therefore, IT based-the
queuing system should be developed also based on multichannel multi-phase queueing model. In order to make it easier
to be implemented, the queue system will be developed in form
of web application. To support the future research, the queue
application should be developed as a module that can be
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