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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 2  |  Issue : 3  |  Page : 209-212

Challenges in application of online registration system in health care in India


1 Associate Professor Cum Principal, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 BSc Nursing 4th Year Student, College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission01-Oct-2020
Date of Decision22-Oct-2020
Date of Acceptance27-May-2021
Date of Web Publication28-Dec-2021

Correspondence Address:
Dr. C Vasantha Kalyani
College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_13_20

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  Abstract 


Background: Online Registration System (ORS) is latest method of appointment in various hospital, which is very easy method and ultimately shorter queues of hospital. No research has been conducted which shows any challenges faced by patients during online registration in hospitals. Aims: The main aim of this study was to investigate challenges faced by patients during online registration in tertiary level hospital, Uttarakhand. Patients and Methods: A cross-sectional descriptive study using non-probability sampling techniques was conducted on 400 patients visiting outpatient department (OPD) using self-structured questionnaire. Results: Majority (99.5%) of participants were familiarised how to operation of smartphone or electronic devices for online registration. Majority (71%) participants were knowing that online OPD registration system is a method of registration in hospital, but only few (26%) were doing it. Main barrier faced by participants that they do not know how to do online registration process, that why they did not do online registration of their patients. Conclusion: The study concludes that online registration process should be simpler so that people can be easily use. More awareness campaign by mass media communication also required, so that people should know how to effectively use ORS.

Keywords: Awareness, health care, online registration system


How to cite this article:
Kalyani C V, Arora G, Chao H, Kaur HD, Kaur H, Malik H, Negi I, Kajal, Kalpana. Challenges in application of online registration system in health care in India. J Med Evid 2021;2:209-12

How to cite this URL:
Kalyani C V, Arora G, Chao H, Kaur HD, Kaur H, Malik H, Negi I, Kajal, Kalpana. Challenges in application of online registration system in health care in India. J Med Evid [serial online] 2021 [cited 2022 Aug 10];2:209-12. Available from: http://www.journaljme.org/text.asp?2021/2/3/209/333951




  Introduction Top


One of the challenges faced by a common man during any hospital visit is long queues of hospitals and more waiting hours for any consultation with physicians. Normal people required lot of time to get prescription from physician.[1] In some tertiary care units, patients wait over-night in long queue to get appointment with their specialised physicians. Hence, for hospital appointment, we need alternative system of registration, which provides easier and earlier health-care services to everyone.[2]

Global and national data showed that around 650 million people will use the internet and smartphone by the next 3 years,[3] which again encourage us also to use this advance technology for better of patients of hospital as well. The use of the internet and online system in health care also minimise human errors and enhance clinical outcomes of every patient.[4],[5] We need well planned online hospital registration application, which is user-friendly for every patient.[1],[6] In India, recently, Online Registration System (ORS) is more frequently used in private sector only. In public sector, the Ministry of Health and Family Welfare also adopts ORS, which is directly linked with patient aadhaar card number. By this, a Unique Health Identification number is generated for each patient, which can be used as a references number for this patients for many years of his/her treatment.[7],[8],[9] By doing ORS, hospital burden for keeping patients' records is also reduced very much.[10],[11] This ORS should be consistently and constantly reviewed for its feasibility and suboptimal use of advance technology for well-being of patients and caregivers.[1],[12],[13],[14] The main focus of this study was to assess general awareness of public for ORS and barriers faced patients for better utilisation of technology in health system.


  Materials and Methods Top


The study used quantitative invariant descriptive design with non-probability purposive sampling technique. The study was conducted in outpatient departments (OPDs) of a tertiary care hospital, Uttarakhand, India. A total 400 adults of age group from 18 to 60, who were visiting various OPD, AIIMS, Rishikesh, were selected for this study. The exclusion criteria used for this study were participants who should not hold any degree in computer science.

Cochrane formula for sample size calculation was used, where, n = Sample size, N = Size of the eligible population, t2 = 1.96, P = 0.34, q = 0.66 and d2 = 0.05.

Data collection involves the use of three research tools. Section I contains sociodemographic profile sheet that includes variables i.e. gender, age, religion, education, occupation, income and habitat. Section II consists of structured questionnaire which consists of questions related to awareness and resources for online registration (3 items) and barriers to ORS (5 items). Section III consists of open-ended suggestions for better utilisation of online registration facilities. The research tools were validated by seven experts of field of medical, nursing and information technology. A pilot study was conducted on 40 participants. The test–retest reliability value of tools was 0.95 and the tools found high reliability.

The study was approved by the institutional ethics committee. Written informed consent was obtained from each participant of the study. Anonymity and confidential were maintained during the study for each participant.

Descriptive statistics i.e. frequency and percentage were calculated using SPSS version 23.0 (IBM SPSS Statistics version 23.0, (IBM Corp., Armonk, N.Y., USA).


  Results Top


Out of 400 participants, the mean age of participants was 37.14 and ratio of male and female was 70:30. Majority participants were Hindu (82%) and educated (66%). Nearly one-fourth of them (20%) were unemployed. Seventy-two per cent of them belong to low socioeconomic status with low family income and belong to urban areas [Table 1].
Table 1: Sociodemographic profile of study participants (n=400)

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Majority (99.5%) of participants were aware with operation of electronic devices and smartphone and know (71%) online OPD registration process. Only few (29%) participants do not know how to do online hospital registration. Few of them (26%) had also used ORS for their registration in hospital, which again point out towards gap between knowledge and utilisation of facilities of ORS [Table 2].
Table 2: Frequency and percentage of awareness regarding online registration (n=400)

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Barriers which explained by participants and come out from this research study were i.e. patients did not know complete process (53%) about how to use online registration. The second barrier was that they still prefer queue methods (18%) because it was easy to adopt it. The third barrier for participants was (14%) that they feel ORS which was very much time-consuming in emergency situation so they prefer queue system over online registration. The fourth barrier faced by participants (8%) was that they still feel it is a complicated process [Figure 1].
Figure 1: Barriers faced by participants during Online Registration System

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Suggestions for better utilisation of online registration facilities were 92% participants suggested that ORS must be used in government hospital preferably. Apart from hospital registration, it must be used for inpatient department (IPD) services, collection of investigation reports and follow-up also [Table 3].
Table 3: Frequency and percentage on suggestions regarding online registration facilities (n=400)

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  Discussion Top


ORS is the use of advance technology for betterment of services provided to patients in hospital. It also fastens service provided by hospitals in public and private sectors. Its services only limited to registration of patients in hospital but for various diagnostic procedures and collected other relevant data and treatment of patient in past. The present study revealed that majority participants have adequate knowledge about electronic devices and smartphone in India. In the present study, majority were educated and employed males, which further support the use of electronic devices (99.5%) i.e. smartphone, whereas another study from San Francisco showed that people with lower literacy rates faced challenge during the use of ORS.[13]

In the present study, finding suggested that majority knows (71%) about ORS and also had previous experience of online OPD registration. A study from Taiwan reported that if anyone has previous experience of ORS, it further has positive reinforcement for using of technology in the future as well.[14]

The study found that most of the Indian population were using the internet for social networking only. A study from China reported that people were also using less online registration portal (36%) for hospital registration.[2] Another study from China also reported that only few (0.7%) people choose ORS for public hospital appointments.[15] Hence, globally and in India, majority of patients still have a trust in queue system of hospital registration, because of its better efficiency.

Our present study also identifies major barriers in better utilisation of ORS in India. Most of people know about ORS of hospital registration but still believe in queue system. A study from Iran showed that main challenge during online registration was found less awareness about how to do ORS.[16] Another qualitative study from Indonesia stated that four major barriers in utilisation of health-care information system were human resources, infrastructure available, organisational support and processing problems.[17] Hence, layman must get proper information about process of ORS. There should be proper training of general public through mass media communication for better utilisation of online registration facilities. Policymakers should keep in mind that ORS should be easy and simple to use. ORS should be reviewed again and again and try to identify obstacles faced by general people as per Indian context.

Lack of information and no prior experience to ORS were major obstacle identified through this study. The current study finding helps various health-care institutions to develop and bring up insight for ORS. They should redesign ORS as per feasibility of patients. This study also highlighted lack of knowledge regarding ORS among general people, and government must emphasise on awareness campaign for better utilisation of ORS for hospital.

The main strength of this study is a large sample size selected for data collection which helps in generalisation of findings of this study.

Limitation of this study was that during time of study data collection, the ORS was used for hospital registration only and it was in starting phase.


  Conclusion Top


Nowadays, advance technology i.e. the internet becomes an important and integral component of every sector including health. The use of advance technology is also increasing day by day in health-care system as well. To increase patient's enforcement for ORS, it should be simple, brief and user-friendly. In public sector hospitals, the ORS must be implementing for OPD and IPD registration, and for diagnostics and reporting services also, which further reduces long waiting times in the queue of hospital and reduces waiting time of patient in hospital. General public must be aware about the use of ORS through an awareness video. Tertiary care hospitals utilise ORS and provide appointment to patients in a slots through online booking. ORS facilitates in tertiary care hospitals can be easily manage for registration of new patients, appointment and monitoring.

Acknowledgement

I would like to extend my sincere thanks to all participants for their cooperation throughout the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zhao P, Yoo I, Lavoie J, Lavoie BJ, Simoes E. Web-based medical appointment systems: A systematic review. J Med Internet Res 2017;19:e134.  Back to cited text no. 1
    
2.
Yu W, Yu X, Hu H, Duan G, Liu Z, Wang Y. Use of hospital appointment registration systems in China: A survey study. Glob J Health Sci 2013;5:193-201.  Back to cited text no. 2
    
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Sandhya Keelery. Available from: https://www.statista.com/topics/2157/internet usage in india. [Last accessed on 2020 Jul 07].  Back to cited text no. 3
    
4.
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5.
Zhang M, Zhang C, Sun Q, Cai Q, Yang H, Zhang Y. Questionnaire survey about use of an online appointment booking system in one large tertiary public hospital outpatient service center in China. BMC Med Inform Decis Mak 2014;14:49.  Back to cited text no. 5
    
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Almomani I, AlSarheed A. Enhancing outpatient clinics management software by reducing patients' waiting time. J Infect Public Health 2016;9:734-43.  Back to cited text no. 9
    
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Campbell D. Best Practices for Online Patient Booking Softworks Group. https://www.softworksgroup.com/synoptec-blog/best-practices-online-patient-booking/. [Last accessed on 2017 Jan 19].  Back to cited text no. 11
    
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Tieu L, Sarkar U, Schillinger D, Ralston JD, Ratanawongsa N, Pasick R, et al. Barriers and facilitators to online portal use among patients and caregivers in a safety net health care system: A qualitative study. J Med Internet Res 2015;17:e275.  Back to cited text no. 13
    
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Yang PC, Chu FY, Liu HY, Shih MJ, Chen TJ, Chou LF, et al. Features of Online Hospital Appointment Systems in Taiwan: A Nationwide Survey. Int J Environ Res Public Health 2019;16:171.  Back to cited text no. 14
    
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Yu W, Yu X, Hu H, Duan G, Liu Z, Wang Y. Use of hospital appointment registration systems in China: A survey study. Glob J Health Sci 2013;5:193-201.  Back to cited text no. 15
    
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Keshvari M, Yusefi A R, Homauni A, Omidifar R, Nobakht S. Barriers for the Using of Information Systems in Hospitals: A Qualitative Study. Shiraz E-Med J 2018;19(8):e66180. doi: 10.5812/semj.66180  Back to cited text no. 16
    
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Afrizal SH, Handayani PW, Hidayanto AN, Eryando T, Budiharsana M, Martha E. Barriers and challenges to Primary Health Care Information System (PHCIS) adoption from health management perspective: A qualitative study. Inform Med Unlocked 2019;17:100198.  Back to cited text no. 17
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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