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Development a Teleconsultation Platform for
Outpatients during the COVID-19 Pandemic based on
Cloud Firestore and Realtime Databases
Khanista Namee*
Faculty of Industrial Technology and
Management
King Mongkut's University of
Technology North Bangkok
Bangkok, Thaialnd
Khanista.N@fitm.kmutnb.ac.th
Orrawan Suwittayapun
Chaophraya Abhaibhubejhr Hospital
Ministry of Public Health
Prachinburi, Thailand
Korapin Infueng
Faculty of Industrial Technology and
Management
King Mongkut's University of
Technology North Bangkok
Bangkok, Thaialnd
Phattaraporn Promsurapat
Faculty of Industrial Technology and
Management
King Mongkut's University of
Technology North Bangkok
Bangkok, Thaialnd
Jantima Polpinij
Intellect Laboratory, Department of
Computer Science
Faculty of Informatics
Mahasarakham University
Mahasarakham, Thailand
Jantima.P@msu.ac.th
Areej Meny
Collage of Applied Medical Sciences
King Saud bin Abdulaziz University for
Health Sciences
Jeddah, Saudi Arabia
Menya@ksau-hs.edu.sa
Abstract—Due to the global epidemic situation of the
Coronavirus Disease 2019 (Covid-19), in addition to serving
patients with suspected symptoms and sickness from COVID-19,
the hospital also provides services to patients outside requiring a
lot of treatment causing a large number of queues in patients. It
takes a long time to wait to see the doctor. The researcher
therefore developed a teleconsultation platform. Hence, that
patients can talk or seek advice from a doctor without the need to
go to the hospital, allow patients to schedule appointments to see a
doctor. Also, the patient can talk to the doctor via video calling
developed in the system. Moreover, doctors can dispense
medicines to patients by mail. To increase the efficiency of the
system more and to support a wide range of applications, any
devices, real-time data updates, appointment notification via
chatbot using Cloud Firestore and Realtime Databases, a NoSQL
database, and study the performance gained. The results obtained
from the test were satisfactory, with an average tracing server
response of 107 ms +0.14%, and an average handling latency in
Thailand at 108 ms.
Index Terms— Teleconsultation, Cloud Firestore, Realtime
Databases, Telemedicine.
I. INTRODUCTION
At present, it can be seen that the outpatient department or
OPD (Outpatient Department) in every government hospital
including during the COVID-19 pandemic. Whether it is a small
community hospital or a large medical center hospital, it faces a
large number of outpatients. From the data collection, it was
found that in small community hospitals, the average number of
outpatients is about 150-300 people per day, for provincial
center hospitals averages about 1,200 - 2,000 people per day,
especially if it is a university hospital with a medical faculty,
there is an average of 10,000 outpatients. – 20,000 people per
day [1, 2, 3] from such a large number resulted in outpatients
who come to the hospital have to wait for a long time. From the
data collection, it was found that the waiting time for outpatients
ranged from 2-8 hours, which can be seen as a very long waiting
time because the doctor took the time to check and diagnose,
prescribe medicine, take only 3-10 minutes in total per patient
only [3].
In addition, another problem that follows is when an
outpatient comes to the hospital for treatment, about 1-2
relatives of the patient will come to help each patient causing the
number of people entering the OPD system to be enormous,
resulting in congestion, congestion, and dissatisfaction with
patients, lose mental health. As for the medical staff, stress
accumulated and not happy at work [4, 5].
This is the reason for the development of this
teleconsultation platform because hospitals in each area have a
large number of patients coming in to use the service every day,
most of whom are patients who need to undergo continuous
medical examinations and to monitor symptoms. The doctor
may make an appointment for the patient to come and check
every other month until the patient's condition stabilizes and
recovers [6]. Also, for some patients who have already improved
may not have to come to the hospital to check again. Because if
patients come to check, it may take a long time to check and will
cause patients to waste time and money in vain which the
organizer has foreseen this problem that the patient must come
to the hospital for the doctor to examine the symptoms.
Especially the group of patients who have recovered and have
recovered do not need to come to check. The organizer wants to
fix this problem, in order to allow patients to receive advice and
consultation from a doctor where the patient does not need to
come to the hospital, just the patient has internet will be able to
consult with a doctor, do not waste time and the cost of going to
The 2022 Biomedical Engineering International Conference (BMEiCON-2022)
: 978-1-6654-8903-4/22/$31.00 ©2022 IEEE
2022 14th Biomedical Engineering International Conference (BMEiCON) | 978-1-6654-8903-4/22/$31.00 ©2022 IEEE | DOI: 10.1109/BMEiCON56653.2022.10012077
Authorized licensed use limited to: King Mongkut's University of Technology North Bangkok. Downloaded on January 24,2023 at 23:46:59 UTC from IEEE Xplore. Restrictions apply.
the hospital. Including the hospital will be able to reduce the
number of patients who will go to the hospital.
The rest of this paper is organized as follows. Section II
provides a brief overview of some theory which had to be
implemented within this research. Then, in Section IV, the
system and network designs are presented in detail. The
experimental deployment is presented in Section IV to
demonstrate the design. The measurement results and
performance are presented in Section V. Finally, conclusions are
drawn in Section VI and following with acknowledgement
section.
II. BACKGROUND
A. Cloud Firestore
Cloud Firestore, one of Firebase's services, helps manage
Database by storing Document Database structure as part of
NoSql Database, making database design more convenient. It
also supports a wide variety of storage formats. Google
announced that Cloud Firestore, a serverless NoSQL document
storage service, has now entered GA state or is now generally
available [7]. Announcing additional expansions, reduced prices
for regional instances, and integration with Stackdriver for
monitoring.
Cloud Firestore is a cloud-native database system managed
by Google. It's designed for storing, syncing, and querying data
for web, mobile, and IoT apps as in Fig.1. The Cloud Firestore
design was focused on simplifying app development. The
database supports sync, work offline, and ACID transactions.
According to Google, Cloud Firestore is designed as a complete
data backend that can manage security and authentication,
infrastructure, sync, and more, and is designed to be fully
integrated with GCP and Firebase. This makes it easy to
integrate with services on both platforms [8].
Figure 1. Cloud Firestore
B. Realtime Database
Realtime Database is a NoSQL database service. It uses a
method to store data as a large JSON tree and can sync status
across clients in realtime. That is, if the same database is
connected to two locations, whenever the data is updated.
Another place will automatically update the same information.
And can work offline on Android and iOS apps [9].
Firebase is a platform that combines tools to help manage
the backend or service side, enabling the creation of mobile
apps efficiently as in Fig.2. Also reduce time and cost or data
analysis as well with both free tools and costly tools. ESP32
devices are fully compatible with firebase. It is another way to
collect data.
Advantages of Firebase Realtime Database is used in the
Realtime Database is the NoSQL database service. It uses a
method to store data in a large JSON Tree and can sync status
across clients in realtime, data update [10]. Another place will
automatically update the same information and can work
offline.
Figure 2. Realtime Database
C. Agora.io
The Agora.io Platform is a global streaming, audio, video
calling and interactive platform for mobile phones or
smartphones and computers by agora.io. The advantages of SD-
RTN™ are: Agora is the world's most widely used and smartest
RTC network dedicated to ultra-low latency with high
availability real-time audio and video both within and between
passengers. 99.995% uptime, support up to 100,000 concurrent
users per broadcast Reliability, lightweight client-side codecs
optimized for low-power devices, built for developers,
developers benefit from Agora's flexible APIs that enable high-
quality audio integration, Ultra-low latency, interactive video
and broadcast Flexible modular design, highly customizable
[11]. Pick and choose which calling or interactive broadcasting
features you want. Easy to deploy SDKs, APIs and code samples
for all popular languages and frameworks [12].
D. Bootstrap
Bootstrap is a Frontend Framework that combines HTML,
CSS and JS for web development that supports every smart
device, known as Responsive Web or Mobile First Bootstrap. It
was developed by a team from Twitter or Twitter.com, which
will see that they look very similar [9]. Currently, the core
development team has a total of 17 people. Bootstrap is a front-
end framework that allows building web applications quickly
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and beautifully. Bootstrap itself has a wide variety of CSS
components and JavaScript plugins to run. Responsive Web,
which allows user to write a website only once, can be run
through the browser on both mobile phones, tablets and general
PCs. Without rewriting, Bootstrap was developed with a group
of developers from all over the world. It is updated all the time
to support modern work and fix various problems.
III. R
ELATED
W
ORKS
Mielczarek (2014) uses simulation (discrete-event
simulation model) to estimate the need for emergency
physicians in terms of quantity and medical costs for the patient.
The study was conducted in a hospital in Poland which is a
regional hospital [13].
Ben-Tovim et al. (2016) developed a patient flow
management system. using simulation Hospital Event
Simulation Model: Arrivals to Discharge or HES-MAD The
model captures the patient arrival characteristics of hospital case
studies in Australia. Using mathematical and statistical
principles to help analyze the simulation process. The results of
the analysis provide a visualization of the dynamic event lesion
change. Helping physicians make decisions hospital
administration staff and related persons [14].
The Kingdom of Saudi Arabia (KSA) has paid great
attention to improving the quality of service of the healthcare
sector, including outpatient clinics (Iman Almomani and Ahlam
AlSarheed, 2016). One of the main disadvantages of outpatient
clinics is waiting. Long waiting times for patients affect the level
of patient satisfaction and quality of service. This article
addresses this issue by studying outpatient management (OMS)
software and proposing a solution to reduce waiting times. Many
hospitals around the world use a solution to long wait times in
outpatient clinics such as hospitals in the US, China, Sri Lanka
and Taiwan. These clinics were successful in reducing wait
times by 15%, 78%, 60% and 50% respectively. Most of these
solutions depended on adding more human resources or making
some business or management policy changes. The solutions
presented in this article reduce wait times by improving the
software used to manage outpatient services. Both quantitative
and qualitative methods are used to understand current OMS and
monitor patient satisfaction levels [15].
The five main issues that can cause high wait times are:
Appointment type, late arrival doctor ticket numbers, early
arrival patients, and patient distribution lists. These issues are
linked to the corresponding OMS components. Such solutions
are recommended and evaluated analytically or by simulated
experiments. Evaluations show that patient wait times are
reduced. When the late doctor arrival issue is resolved, this can
reduce clinic service time by as much as 20%. However, the
solution for early arrival patients cuts 53.3%, 20% of clinic time,
and 30.3% of total waiting time Finally, a good patient
distribution list resulted in a 54.2% improvement. Improving
patient waiting times would affect patient satisfaction and
improve the quality of health care services [16].
Kamal Hussain et al. (2013) presented an idea on the role of
health information management in the context of a technology-
driven healthcare environment and management. This article
will give you an idea of health, information management and
technological change in the new era of the healthcare industry.
The adoption of technology has helped to reduce the congestion
of OPD patients in Saudi Arabia. For example, an organization
wants to go paperless, its data strategy must have the right tools
to store and access unstructured data components of medical
records, e.g. same as structured data Electronic Health
Management [17].
IV. D
ESIGN AND
I
MPLEMENTATION OF
T
ELECONSULTATION
P
LATFORM
A. System Architecture
Fig.3 is an architectural image of an online outpatient
counseling system during the COVID-19 situation. The data is
stored in Firebase where all users can view their own data on the
user's permissions display.
There are 5 groups of users in the
system, consisting of admin, doctor, pharmacist, volunteer and
patient.
Figure 3. System Architecture
B. Storage Structure in Firebase
Firebase's functions used by online outpatient counseling
systems during COVID-19 are Firebase Realtime Database and
Firebase Cloud Firestore. Used to collect patient information
and information that patients make inquiries or ask questions to
the doctor. information of the doctor's history Pharmacist history
History of volunteers, drug information, disease information.
Also, press release medical queue management Patient queuing,
medication storage, and Firebase Storage used to store patient
image files attached to questions. Keep patient's ID card image
file and image file for attaching proof of payment.
C. A schematic diagram of the operation of the
Teleconsultation Platform
• Issue the Prescription is the prescription page. After the
video call is complete, the doctor will issue a
prescription to the patient in case the patient needs
medication. There will be details of the name of the
drug. and the amount of medication the patient will
receive.
• Schedule Date/Time is to set the date/time schedule.
The doctor will determine the date and time to consult.
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• Book an appointment is to book an appointment where
users can choose a day and time that is convenient for
consulting with the doctor.
• Pay Medical Bills is the payment page. It will be the
duty of the patient to pay for medicines and medical
expenses. Payments can be made by scanning a QR
Code and having the user enter the correct address
where the medicine can be delivered.
Figure 4. Storage structure in Firebase
Figure 5. A schematic diagram of the operation of Teleconsultation Platform
V. R
ESULTS AND
D
ISCUSSION
A. Firebase Storage
The table is an example of The Online Outpatient
Department Advisory Services System during the Covid-19
Situation of the Online Outpatient Department Advisory
Services System during the Covid-19 situation used to collect all
data within the online outpatient consultation system during the
COVID-19 situation. All data will be collected as follows: store
payment information chat archive Keep the doctor's department
information. Collect question search information. collect
questions Collect question search information. Store booking
information Store all user data store prescription information
chat archive Store access data collect statistical data and collect
information.
TABLE I.
F
IREBASE
C
LOUD
F
IRESTORE
Firebase Cloud Firestore
Data Description
blogPosts Collect various news information
Billings store payment information
Chats chat archive
Manageoption Keep the doctor's department information
Medics Store drug information in the warehouse
OrderMedic store prescription information
Question collect questions
Queues Store booking information
Users Store all user data
stats collect statistical data
B. Measuring Realtime Database Performance
Once the development of the platform is complete Next, we
want to know the performance gains when it comes to realtime
database applications. We want to know how fast this system is.
When you combine a low-latency websocket connection with
the SDK's local caching capabilities, the changes are
immediately felt.
Including we want to know How fast is our
database working for real-world users? As a good app developer,
we need to collect real-world performance data to ensure that
our real-world app experience meets user expectations. Many in
the tech industry call these field measurements Real User
Monitoring (RUM), and they are the gold standard for
measuring app performance and user experience. Firebase
Performance Monitoring is a free cross-platform service that
helps us collect and Analyze RUM data for our app or website.
TABLE II.
M
EASURING
R
EALTIME
D
ATABASE
P
ERFORMANCE
Realtime Database Performance
Parameter Values
Tracing server responses Average 107 ms
Handling latency: Thailand Average 108 ms
Handling latency: USA Average 380 ms
Handling latency: UK Average 190 ms
Handling latency: Japan Average 155 ms
Handling latency: Germany Average 176 ms
Firebase Performance Monitor automatically measures
common metrics such as initial paint time and HTTP request
performance. Because real-time databases use WebSocket
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connections that take longer than separate HTTP requests, we
need to use Custom. Traces to monitor the efficiency of our
database operations.
VI. CONCLUSION
Due to the global epidemic situation of the coronavirus
disease 2019 (Covid-19) has a wide impact on all sectors,
especially the medical and public health systems. In addition to
serving patients who are suspected and sick from COVID-19,
the hospital also provides outpatient services that require
treatment without having to stay in the hospital to be treated in
a large number of hospitals and cause a large number of queues
in patients. It takes a long time to wait to see the doctor. The
researcher is aware of this problem. Therefore, a teleconsultation
platform has been developed. Hence, that patients can talk or
seek advice from a doctor without the need to go to the hospital.
The platform allows patients to schedule appointments to see
a doctor, know the schedule when the doctor is available. Also,
can talk to the doctor via video calling developed in the system
and doctors can dispense medicines to patients by mail. The
target group of those who will use the system is the same group
of patients who need to come to the doctor at the appointed time
and has a history of treatment at the hospital. For increase the
efficiency of the system more to support a wide range of
applications, any devices, real-time data updates, appointment
notification via chatbot using Cloud Firestore and Realtime
Databases, a NoSQL database, and study the performance
gained.
ACKNOWLEDGMENT
The work of this project is a collaboration between the
National Science and Technology Development Agency
(NSTDA) and King Mongkut’s University of Technology North
Bangkok (KMUTNB), Thailand. Contract no. JRA-CO-2563-
13727-TH. We would like to deliver our greatest appreciation
for their support.
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