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Appointments & Scheduling Use Cases

Implementation Note: Appointment scheduling integrates with HL7 SIU messages for legacy systems and provides REST APIs for modern interfaces. All scheduling respects doctor availability, room/resource constraints, and patient preferences.

UC-APPT-001: Register New Patient

Purpose: Create patient record with demographics, ABHA verification, and duplicate detection.

Property Value
Actor Registration Desk / Patient Portal
Trigger New patient arrival or online registration
Priority P0

Main Success Scenario: 

1. Collect patient demographics:
   - Name, DOB, Gender
   - Phone, Email, Address
   - Photo (optional)
2. Verify ABHA ID (if provided):
   - Call ABDM ABHA verification API
   - Fetch linked health records consent
3. Check for duplicates:
   - Match on Name + DOB + Phone
   - Fuzzy match on Aadhaar last 4 digits
4. If duplicate found:
   - Present existing record for review
   - Merge or create new based on staff decision
5. Generate MRN (Medical Record Number)
6. Create patient record in system
7. Issue registration receipt/token

Acceptance Criteria:

  1. [ ] ABHA verification in < 3 seconds
  2. [ ] Duplicate detection accuracy > 95%
  3. [ ] MRN format: HOSP-YYYY-NNNNN
  4. [ ] Patient photo capture (mobile/webcam)
  5. [ ] Aadhaar-based eKYC (optional)

India-Specific:

  • ABHA ID verification via ABDM APIs
  • Aadhaar eKYC integration (optional)
  • PM-JAY beneficiary verification
  • CGHS/ECHS beneficiary lookup

UC-APPT-002: Book OPD Appointment

Purpose: Schedule outpatient consultation with doctor availability check.

Property Value
Actor Registration Desk / Patient App
Trigger Patient requests appointment
Priority P0

Main Success Scenario: 

1. Select department and doctor (or "Any available")
2. Query doctor availability:
   - Fetch schedule from roster
   - Check existing appointments
   - Account for buffer time between slots
3. Display available slots:
   - Date, Time, Duration
   - Consultation fee
4. Patient selects preferred slot
5. Collect appointment details:
   - Reason for visit (optional)
   - Insurance/payment mode
6. Create appointment record
7. Send confirmation:
   - SMS/WhatsApp with details
   - Calendar invite (optional)
8. Update doctor's schedule

Acceptance Criteria:

  1. [ ] Real-time availability check
  2. [ ] Slot duration configurable per doctor
  3. [ ] Buffer time between appointments
  4. [ ] Multi-language confirmation (English/Hindi)
  5. [ ] Cancellation/reschedule support

UC-APPT-003: Doctor Availability Management

Purpose: Configure and manage doctor schedules, leave, and availability.

Property Value
Actor Admin / Doctor
Trigger Schedule configuration or leave request
Priority P1

Main Success Scenario: 

1. Define regular schedule:
   - Days of week
   - Start/end times per day
   - Slot duration (15/20/30 min)
   - Max patients per slot
2. Configure recurring patterns:
   - Weekly OPD schedule
   - Monthly special clinics
3. Mark exceptions:
   - Leave/holidays
   - Conference days
   - Emergency availability
4. Handle leave requests:
   - Doctor submits leave request
   - Admin approves/rejects
   - System blocks affected slots
   - Notify affected patients
5. Manage substitutions:
   - Assign covering doctor
   - Transfer appointments

Acceptance Criteria:

  1. [ ] Calendar view of doctor schedule
  2. [ ] Bulk slot creation
  3. [ ] Leave management workflow
  4. [ ] Patient notification on cancellation
  5. [ ] Audit trail for schedule changes

UC-APPT-004: Check-In Patient for Appointment

Purpose: Mark patient arrival and update queue for consultation.

Property Value
Actor Registration Desk / Self-Service Kiosk
Trigger Patient arrives for appointment
Priority P0

Main Success Scenario: 

1. Identify patient:
   - Scan appointment QR code
   - Search by name/phone/MRN
   - ABHA ID lookup
2. Verify appointment:
   - Confirm date/time/doctor
   - Check payment status
3. Collect vitals (if nursing station):
   - Weight, Height, BP, Temp
   - Chief complaint
4. Update appointment status: "Checked In"
5. Add to doctor's queue:
   - Calculate wait time
   - Assign queue number
6. Issue token:
   - Print token with queue number
   - Display on waiting room screen
7. Notify doctor of patient arrival

Acceptance Criteria:

  1. [ ] QR-based fast check-in (< 30 sec)
  2. [ ] Real-time queue display
  3. [ ] Vital capture integration
  4. [ ] Wait time estimation
  5. [ ] Multi-doctor queue support

UC-APPT-005: OPD Queue Management

Purpose: Manage real-time patient queue and display wait times.

Property Value
Actor Queue Display System / Staff
Trigger Patient checked in or called
Priority P1

Main Success Scenario: 

1. Maintain queue per doctor/room:
   - Ordered by check-in time
   - Priority flags (elderly, emergency)
2. Display current queue:
   - Now serving: Token #XXX
   - Estimated wait times
3. Doctor calls next patient:
   - Click "Next Patient" in UI
   - Queue display updates
   - Audio/visual announcement
4. Handle queue exceptions:
   - Skip patient (not present)
   - Emergency insertion
   - Patient leaves without consultation
5. Calculate analytics:
   - Average wait time
   - Consultation duration
   - No-show rate

Acceptance Criteria:

  1. [ ] Real-time queue display (TV/monitor)
  2. [ ] Audio call announcements
  3. [ ] Priority queue support
  4. [ ] Average wait time calculation
  5. [ ] Integration with consultation start/end

UC-APPT-006: Reschedule Appointment

Purpose: Allow patients or staff to reschedule existing appointments.

Property Value
Actor Patient / Registration Desk
Trigger Reschedule request
Priority P1

Main Success Scenario: 

1. Identify appointment:
   - By confirmation number
   - By patient lookup
2. Check reschedule policy:
   - Minimum notice period (e.g., 4 hours)
   - Maximum reschedules allowed
3. Show available alternative slots
4. Confirm new slot selection
5. Update appointment record:
   - Mark original as rescheduled
   - Create new appointment
   - Link for audit trail
6. Send notifications:
   - Confirmation to patient
   - Update doctor calendar
7. Release original slot for rebooking

Acceptance Criteria:

  1. [ ] Policy-based reschedule limits
  2. [ ] No-fee reschedule within 24 hours
  3. [ ] Multi-channel reschedule (app, web, call)
  4. [ ] Audit trail of all changes
  5. [ ] Automatic slot release

UC-APPT-007: Cancel Appointment

Purpose: Process appointment cancellation with refund handling.

Property Value
Actor Patient / Registration Desk
Trigger Cancellation request
Priority P1

Main Success Scenario: 

1. Identify appointment
2. Check cancellation policy:
   - Cancellation fee based on notice period
   - Free cancellation window
3. Confirm cancellation with patient
4. Process refund (if applicable):
   - Full refund within policy
   - Partial refund with fee deduction
   - No refund outside window
5. Update appointment status: "Cancelled"
6. Release slot for rebooking
7. Send cancellation confirmation
8. Update doctor's schedule

Acceptance Criteria:

  1. [ ] Configurable cancellation policies
  2. [ ] Automatic refund processing
  3. [ ] Slot immediately available for rebooking
  4. [ ] Cancellation reason capture
  5. [ ] No-show vs. cancellation differentiation

UC-APPT-008: Follow-Up Appointment Booking

Purpose: Schedule follow-up visits based on doctor recommendation.

Property Value
Actor Doctor / Staff
Trigger Doctor recommends follow-up
Priority P1

Main Success Scenario: 

1. Doctor indicates follow-up needed:
   - Follow-up in X days/weeks
   - Specific tests before follow-up
2. System suggests available slots:
   - Same doctor preferred
   - Time preference (same time of day)
3. Staff/patient confirms slot
4. Create appointment linked to original visit
5. If tests required:
   - Create test orders
   - Link test results to follow-up
6. Send reminder sequence:
   - T-7 days: Pre-visit reminder
   - T-1 day: Appointment reminder
   - T-4 hours: Final reminder

Acceptance Criteria:

  1. [ ] Doctor-initiated follow-up workflow
  2. [ ] Pre-requisite test tracking
  3. [ ] Smart reminder sequence
  4. [ ] Visit linkage for continuity
  5. [ ] Follow-up compliance tracking

UC-APPT-009: Schedule Telemedicine Appointment

Purpose: Book video/audio consultation with doctor.

Property Value
Actor Patient / Registration Staff
Trigger Patient requests teleconsultation
Priority P0

Main Success Scenario: 

1. Patient selects telemedicine option:
   - Department/Specialty
   - Doctor (or any available)
2. Check telemedicine availability:
   - Doctor's teleconsult slots
   - Platform availability
3. Collect consultation details:
   - Chief complaint
   - Preferred language
   - Device compatibility check
4. Payment processing:
   - Consultation fee display
   - Online payment
   - Insurance/TPA if applicable
5. Confirm appointment:
   - Generate meeting link
   - Send confirmation with link
   - Add to doctor's calendar
6. Pre-consultation:
   - Share instructions (device setup)
   - Symptom questionnaire link
   - Document upload option

Acceptance Criteria:

  1. [ ] Multi-platform support (web, mobile)
  2. [ ] Device/bandwidth testing
  3. [ ] Secure meeting link generation
  4. [ ] Payment integration
  5. [ ] Reminder notifications

India-Specific:

  • Telemedicine Guidelines 2020 compliance
  • eSanjeevani integration (optional)
  • ABDM consent for data sharing

UC-APPT-010: Schedule Surgery

Purpose: Book operation theatre slot with surgeon, anesthesiologist, and resource allocation.

Property Value
Actor OT Coordinator / Surgeon
Trigger Surgery request from doctor
Priority P0

Main Success Scenario: 

1. Receive surgery request:
   - Patient details
   - Procedure type (ICD-10-PCS / CPT)
   - Surgeon preference
   - Urgency (Elective/Urgent/Emergency)
2. Check OT availability:
   - Theatre rooms
   - Equipment requirements
   - Estimated duration
3. Check personnel availability:
   - Primary surgeon
   - Anesthesiologist
   - Nursing staff (scrub, circulating)
4. Validate pre-requisites:
   - Pre-operative investigations complete
   - Anesthesia fitness clearance
   - Consent obtained
   - Blood arranged (if required)
5. Allocate resources:
   - Assign OT room
   - Block equipment
   - Reserve PACU/ICU bed
6. Create surgery schedule entry
7. Notify all stakeholders:
   - Surgeon, Anesthesiologist
   - OT nursing staff
   - Ward nursing (patient prep)
   - CSSD (instrument sterility)

Acceptance Criteria:

  1. [ ] Real-time OT calendar view
  2. [ ] Conflict detection (double-booking)
  3. [ ] Equipment availability check
  4. [ ] Pre-requisite checklist enforcement
  5. [ ] Multi-stakeholder notifications

India-Specific:

  • NABH OT scheduling compliance
  • MLC case flagging
  • Ayushman Bharat package rate display

Scheduling Integration Architecture

flowchart TB
    subgraph "Channels"
        A["Patient App"]
        B["Web Portal"]
        C["Call Center"]
        D["Kiosk"]
    end

    subgraph "Scheduling Engine"
        E["Availability Service"]
        F["Booking Service"]
        G["Queue Manager"]
        H["Notification Service"]
    end

    subgraph "External Systems"
        I["HL7 SIU (ADT)"]
        J["Doctor Calendar"]
        K["Payment Gateway"]
        L["ABDM (ABHA)"]
    end

    A --> F
    B --> F
    C --> F
    D --> G
    F --> E
    F --> K
    F --> H
    G --> H
    I --> F
    E --> J
    F --> L

Document Owner: Product Manager / Integration Lead
Last Updated: 2024-12-09
Related: Notifications | Ingestion - HL7