DEMOCRATIC AND POPULAR ALGERIAN REPUBLIC

MINISTRY OF HIGHER EDUCATION AND SCIENTIFIC RESEARCH

IBN KHALDOUN UNIVERSITY - TIARET

Dissertation
Presented to :

FACULTY OF MATHEMATICS AND COMPUTER SCIENCE

COMPUTER SCIENCE DEPARTMENT

In order to obtain the degree of :

MASTER
Specialty: Software Engineering

In order to create a Startup :

Presented by :
DIOP Mohamed
CHEBICHEB Kheir Eddine
On the theme :

Towards an Integrated Health Management System in Algeria with Collaborative

Communication: Development of an e-Health Platform for Cooperation between Health
Professionals, Patients, and Medical Imaging Laboratories

Defended publicly on June 11, 2024 in Tiaret in front the jury composed of:

Mr OUARED Abdelkader MCA Tiaret University President

Mr TALBI Omar MCA Tiaret University Supervisor
Mr MERATI Medjeded MCA Tiaret University Examiner
Mr BELADJINE Khaldia MCA Tiaret University Incubator representative
Mr SEKIOU Anwar Organization Representative of the
economic partner

2023-2024
Acknowledgments

2
 Acknowledgments

First and foremost, we would like to thank Allah SWT for granting us the strength and
health to complete this project.
We would like to extend our deepest gratitude to our supervisor Mr TALBI Omar,
especially for his availability, his deep understanding of our ideas, and his guidance,
which has continuously motivated, encouraged, and steered us towards the path of
success in this project.
We would also like to thank the members of the jury for dedicating their time to
examine this project and provide critiques and suggestions to improve it.
Additionally, we express our gratitude to the hosting organizations during our
internships at EPSP - Tiaret, EPSP - Ain Kermes, and the Medical Diagnostic Center
EL AMAL for their hospitality and support in providing us with the necessary
information and resources needed for the completion of this project.
Finally, we thank all the individuals who directly or indirectly contributed to the
realization of this project, especially those who encouraged us with their ideas and
provided feedback aimed at its improvement.
Dedications

4
 Dedication

I take this special occasion to thank my parents, my family in Senegal as

well as in Mali and all my close friends for their support.
I thank my dear mother for her support during my higher studies and for
all these blessings for my success, may Allah SWT reward her.
I sincerely thank my uncle Arona Diop for his availability and his
support as a tutor, father and person in charge of me, I will never stop
thanking him.
I particularly thank the Sissoko family in Mali for their support, may
Allah SWT reward them.
Finally, I would like to thank all those people who have been able to help
me directly or indirectly in my success, may this modest work be the
fulfillment of your many wishes, the fruit of your countless sacrifices. May
God, the Almighty, grant you health, happiness and longevity.

– Mohamed Diop
 Dedication

I take this special occasion to thank my parents, family, and close friends
for their support. I express my heartfelt gratitude to my dear mother for
her unwavering support during my studies and for her countless blessings
for my success; may Allah SWT reward her.
I thank My brothers for their support during my studies and all these
blessings for my success, may Allah SWT reward her.
I sincerely thank My maternal aunt Abid Fatiha for his availability and
his support as a tutor, father, and person in charge of me, I will never
stop thanking him.
I would also like to sincerely thank healthcare professionals, especially
Dr. Mehdi Takieddine, Hamdi Fatiha,Kaddari Mhamed, and the
medical students for their support; may Allah SWT reward them.
Finally, I would like to thank all those who have helped me directly or
indirectly in my journey. May this modest work be a fulfillment of your
many wishes and a fruit of your countless sacrifices. May God, the
Almighty, grant you health, happiness, and longevity.

– Chebicheb Kheireddine
Abstract

7
Abstract

Effective and efficient collaboration between the patient and their medical environment,
as well as inter-professional cooperation, are essential to ensure quality care. Information
and Communication Technologies (ICT) emerge as a solution aimed at facilitating this
process. In Algeria, the digitization of healthcare services is receiving considerable at-
tention from authorities, as evidenced by recent decrees on the subject. Although this
process has already been initiated, there are still challenges to be addressed in terms
of communication, centralization of healthcare services, patient empowerment, medical
data management, care coordination, and adaptation to new technologies, particularly
Artificial Intelligence (AI).
To address these challenges, a set of two platforms—a mobile application for pa-
tients and a web application for healthcare professionals—has been developed, facilitat-
ing their collaboration in the care process. Using an agile methodology such as SCRUM,
this project empowers patients by providing medical information features like a chat bot,
management of their Electronic Health Record (EHR), and teleconsultation. Addition-
ally, it offers better cooperation among healthcare professionals through features such as
telemedicine, decision support assistants, and full access to EHR.

Keywords: e-Health, patient empowerment, integrated platform, electronic medical

records, health management, collaborative communication, Algeria, health information
system, AI in healthcare.

8
 ‘jÊÓ

, áJ“A’JkB@ áK. àðAªJË@ úÍ@ é¯A“B AK. , éJ J.¢Ë@ éJJK. ð ‘ QÖÏ @ áK. èZA®ºË@ð ÈAª®Ë@ àðAªJË@
(ICT) HBA’  B@ð HAÓñʪÖ Ï @ AJk. ñËñJºK Qê¢ . èXñm.Ì '@ H@
 X éJ j’Ë@ éK A«QË@ àAÒ’Ë ø PðQå• QÓ @
  g ÉK ñm' ù®Ê JK ,QK@Qm.Ì '@ ú¯ . éJ ÊÒªË@ è Yë ÉJîD„ úÍ@ ¬YîE Ém»
éJ Ô¯QË@ úÍ@ éJ j’Ë@ éK A«QË@ HAÓY
è Yë à @ áÓ Ñ«QË@ úΫ . ¨ñ“ñÖÏ @ Èñk èQg B@ Õæƒ@QÖÏ @ áÓ i’JK AÒ» , HA¢Ê‚Ë@   Jë@
áÓ @Q J.» AÓAÒ
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 JK HAK
HAJ  k. ñËñJºJË@ ©Ó ­JºJË@ð , éK A«QË@ ‡J ‚Kð , éJ J.¢Ë@ HA  KAJJ.Ë@ èP@X@ ð ,úæ•QÖÏ @ áºÖßð , éJ j’Ë@
. (AI) ú«AJ’Ë@ ZA¿YË@ é“A  gð , èYK YmÌ '@
.
‡JJ¢ð úæ•QÒÊË ÈñÒm× ‡J J¢ - áJ’JÓ áÓ é«ñÒm  × QK ñ¢ Õç' , HAK   
YjJË@ è Yë éêk. @ñÖÏ
. . .
ÉJÓ éKQÓ éJj.îDÓ Ð@YjJƒAK. . éK A«QË@ éJÊÔ« ú¯ ÑîEðAªK ÉJîD„JË - áJj’Ë@ á¯QjÒÊË I.K ð
   
ÉJÓ éJ J.¢Ë@ HAÓñʪÖ
  QÓ Q¯ñK ÈCg áÓ úæ•QÖÏ @ áºÖß ¨ðQå„ÖÏ @ @ YêË áºÖß , SCRUM
Ï @ H@
.YªK. á« H@  ð , (EHR) éJ Kð QºËB @ éJ j’Ë@ ÑîECm
 P A‚ ƒB@  . èP@X@ ð , éJ KñK. ðQË@ éƒXPYË@

 QÓ ÈCg áÓ áJj’Ë@ á¯QjÖÏ @ áK. ɒ¯ @ AKðAª   
á« I.¢Ë@ ÉJÓ H@ K ÐY®K ,½Ë X úÍ@ é¯A“B AK.
éJ Kð QºËB @ éJ j’Ë@ HCj  . ‚Ë@ úÍ@ ÉÓA¾Ë@ Èñ“ñË@ð ,P@Q®Ë@  XAm' @ ú¯ Ñ«YË@ ø Y«A‚Óð ,YªK
.
. (EHR)

, éJ Kð QºË@ éJ J.£ HCm  JÓ é’

 . , éÊÓA¾  JÓ , ‘ QÖÏ @ áºÖß , éJ Kð QºËB @ éj’Ë@
 : éJ kAJ®Ó HAÒÊ¿

. ú«AJ’Ë@ ZA¿YË@ , éJ m• HAÓñʪÓ
 
ÐA¢ ,QK@Qm.Ì '@ ,úGðAªK ɓ@ñK , éj’Ë@ èP@X@

9
Résumé

Une collaboration efficace et efficiente entre le patient et son environnement médical,

ainsi que la coopération interprofessionnelle, sont essentielles pour garantir des soins de
qualité. Les technologies de l’information et de la communication (TIC) apparaissent
comme une solution visant à faciliter ce processus. En Algérie, la numérisation des services
de santé reçoit une attention considérable de la part des autorités, comme en témoignent
les récents décrets sur le sujet. Bien que ce processus ait déjà été amorcé, il reste encore
des défis à relever en termes de communication, de centralisation des services de santé,
d’autonomisation des patients, de gestion des données médicales, de coordination des soins
et d’adaptation aux nouvelles technologies, notamment l’intelligence artificielle (IA).
Pour relever ces défis, un ensemble de deux plateformes - une application mo-
bile pour les patients et une application web pour les professionnels de la santé - a
été développé, facilitant leur collaboration dans le processus de soins. En utilisant une
méthodologie agile telle que SCRUM, ce projet permet d’autonomiser les patients en leur
fournissant des fonctionnalités d’informations médicales comme un chatbot, la gestion
de leur dossier électronique médical (DEM), et la téléconsultation. De plus, il offre une
meilleure coopération entre les professionnels de la santé grâce à des fonctionnalités telles
que la télémédecine, des assistants à la prise de décision, et un accès complet aux dossiers
électroniques médicaux (DEM).

Mots-clés : e-santé, empowerment du patient, plateforme intégrée, dossiers médicaux

électroniques, gestion de la santé, communication collaborative, Algérie, Système d’Information
Sanitaire, l’IA dans les soins de santé.

10
Contents

Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

General Introduction 20
Study Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Problem Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Structure of the Thesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

1 E-Health and the Patient 23

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
1.1 E-Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
1.1.1 Telehealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
1.1.2 Medical Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
1.1.3 Health Information System . . . . . . . . . . . . . . . . . . . . . . . 26
1.1.4 AI and Robotic in Healthcare . . . . . . . . . . . . . . . . . . . . . 29
1.2 From Passive Patient to Autonomous Patient . . . . . . . . . . . . . . . . 30
1.2.1 E-Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
1.2.2 Patient-Professional Relationships . . . . . . . . . . . . . . . . . . . 31
1.2.3 Patient Empowerment . . . . . . . . . . . . . . . . . . . . . . . . . 31
1.2.4 The Patient Acceptance Challenge . . . . . . . . . . . . . . . . . . 32
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

2 Literature Review 34
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2.1 Research Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2.1.1 Literature review internships . . . . . . . . . . . . . . . . . . . . . . 34
2.1.2 Online Databases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2.1.3 Market Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
2.2 Related Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
2.2.1 Related Platforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
2.2.2 Thematic Literature Review . . . . . . . . . . . . . . . . . . . . . . 46
2.2.3 Evaluation criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
2.2.4 Synthesis and Critical Analysis . . . . . . . . . . . . . . . . . . . . 50
2.3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

3 Requirements Specification 56
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
3.1 Market Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
3.1.1 Key Questions and Answers . . . . . . . . . . . . . . . . . . . . . . 56
3.1.2 Synthesis and Conclusion . . . . . . . . . . . . . . . . . . . . . . . . 60

11
 3.2 Scrum Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
3.2.1 Product Backlog . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
3.2.2 Sprint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
3.2.3 Sprint Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
3.3 Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
3.3.1 Actors Identification . . . . . . . . . . . . . . . . . . . . . . . . . . 62
3.3.2 Functional Requirements . . . . . . . . . . . . . . . . . . . . . . . . 63
3.3.3 Non-functional Requirements . . . . . . . . . . . . . . . . . . . . . 64
3.4 Use Case Diagrams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
3.4.1 Patient’s Use Case Diagrams . . . . . . . . . . . . . . . . . . . . . . 65
3.4.2 Healthcare Professionals’ Use Case Diagrams . . . . . . . . . . . . . 69
3.4.3 Administrators’ Use Case Diagrams . . . . . . . . . . . . . . . . . . 74
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

4 Analysis and Design 79

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
4.1 Class Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
4.2 Sequence Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
4.3 System Architecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
4.3.1 Database Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
4.4 UX/UI Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
4.4.1 User Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
4.4.2 User Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
4.5 Business Model Canvas (BMC) . . . . . . . . . . . . . . . . . . . . . . . . 92
4.5.1 Key Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
4.5.2 Key Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
4.5.3 Key Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
4.5.4 Value Propositions . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
4.5.5 Customer Relationships . . . . . . . . . . . . . . . . . . . . . . . . 94
4.5.6 Channels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
4.5.7 Customers Segments . . . . . . . . . . . . . . . . . . . . . . . . . . 95
4.5.8 Cost Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
4.5.9 Revenue Streams . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

5 Realization 98
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
5.1 Technical and Technological Choices . . . . . . . . . . . . . . . . . . . . . 98
5.1.1 Collaboration and Design Technologies . . . . . . . . . . . . . . . . 98
5.1.2 Mobile development tools . . . . . . . . . . . . . . . . . . . . . . . 100
5.1.3 Web development technologies . . . . . . . . . . . . . . . . . . . . . 101
5.2 Bidirectional Encoder Representations from Transformers for Biomedical
Text Mining (BioBERT) Fine-tuning . . . . . . . . . . . . . . . . . . . . . 102
5.2.1 Dataset: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
5.2.2 Implementation Steps . . . . . . . . . . . . . . . . . . . . . . . . . 103
5.3 Interfaces Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
5.3.1 Web application Interfaces . . . . . . . . . . . . . . . . . . . . . . . 104
5.3.2 Mobile App Interfaces . . . . . . . . . . . . . . . . . . . . . . . . . 108
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

12
6 General Conclusion 114
Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

A Internship Reports 115

13
List of Figures

1.1 Diagram illustrating the different components of e-health. Adapted from

[1, 2] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
1.2 Diagram of key interactions in knowledge-based and non-knowledge based
Clinical Decision Support System (CDSS). From [3] . . . . . . . . . . . . . 28
1.3 Structure of Online Health Information Resources (OHIR). . . . . . . . . . 29
1.4 Mapping input data to diagnosis and treatment decision. Adapted from [4] 30

2.1 DEM DZ Dashboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

2.2 Pharm’Net website. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
2.3 santedz website. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
2.4 annumed website. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
2.5 eventmed website . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
2.6 Updox overview from [5]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
2.7 RayScan Manipulation Software . . . . . . . . . . . . . . . . . . . . . . . . 41
2.8 Doctolib Mobile Application. . . . . . . . . . . . . . . . . . . . . . . . . . . 42
2.9 Doctolib Website. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
2.10 Drugs.com website. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
2.11 Response of GET https://api.fda.gov/drug/label.json? . . . . . . . 44
2.12 OpenFDA API calls statistics. . . . . . . . . . . . . . . . . . . . . . . . . . 45
2.13 Symptom Evaluation in the Ada Application. . . . . . . . . . . . . . . . . 46
2.14 Fine-tuning of BioBERT. From [6] . . . . . . . . . . . . . . . . . . . . . . 48

3.1 Q2 Answers graphic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

3.2 Q3 Answers graphic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
3.3 Q4 Answers graphic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
3.4 Q5 Answers graphic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
3.5 Q6 Answers graphic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
3.6 Scrum Process. From [7]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
3.7 Context Diagram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
3.8 Patient’s Use Case Diagram (UCD) #1: Get account. . . . . . . . . . . . . 65
3.9 Patient’s UCD #2: All System Mobile App use cases. . . . . . . . . . . . . 66
3.10 Patient’s UCD #3.1: Account and Medical Record Management #1. . . . 67
3.11 Patient’s UCD #3.2: Account and Medical Record Management #2. . . . 67
3.12 Patient’s UCD #3.3: Account and Medical Record Management #3. . . . 68
3.13 Patient’s UCD #4: Search and Contact Health Professionals. . . . . . . . . 69
3.14 Patient’s UCD #5: Appointments Management and Emergency Reporting. 69
3.15 Healthcare Professionals Generalization. . . . . . . . . . . . . . . . . . . . 70
3.16 Healthcare Professionals’ UCD #1: All System Web App use cases for
Healthcare Professionals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
3.17 Healthcare Professionals’ UCD #2: Account Management. . . . . . . . . . 72
3.18 Healthcare Professionals’ UCD #3: Search Patient and Contact him. . . . 72

14
3.19 Healthcare Professionals’ UCD #4: Collaborate with Professionals. . . . . 73
3.20 Healthcare Professionals’ UCD #5: Patient’s Medical Records (PMRs)
Management #1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
3.21 Healthcare Professionals’ UCD #6: PMRs Management #2. . . . . . . . . 73
3.22 Administrators’ UCD #1: All System Web App use cases for Administrators. 74
3.23 Administrators’ UCD #2: Users Management #1. . . . . . . . . . . . . . . 75
3.24 Administrators’ UCD #3: Users Management #2. . . . . . . . . . . . . . . 75
3.25 Administrators’ UCD #4: Users Management #3. . . . . . . . . . . . . . . 76
3.26 Administrators’ UCD #5: Organization Management. . . . . . . . . . . . . 76

4.1 Class Diagram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

4.2 Appointments Sequence Diagram #1. . . . . . . . . . . . . . . . . . . . . . 81
4.3 Appointments Sequence Diagram #2. . . . . . . . . . . . . . . . . . . . . . 82
4.4 Prescription Sequence Diagram. . . . . . . . . . . . . . . . . . . . . . . . . 83
4.5 System Configuration Sequence Diagram. . . . . . . . . . . . . . . . . . . . 84
4.6 System Architecture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
4.7 Mobile App Wireframe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
4.8 Web App welcome and login Wireframe. . . . . . . . . . . . . . . . . . . . 89
4.9 Web App Dashboard Wireframe . . . . . . . . . . . . . . . . . . . . . . . . 89
4.10 Web App for Hover interface . . . . . . . . . . . . . . . . . . . . . . . . . 90
4.11 Color Palette. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
4.12 Mobile Prototypes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
4.13 Web Prototypes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
4.14 Logo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
4.15 BMC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

5.1 Overleaf Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

5.2 Figma Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
5.3 Android Studio Environment. . . . . . . . . . . . . . . . . . . . . . . . . . 101
5.4 Web App Interface #1 : Welcome Page . . . . . . . . . . . . . . . . . . . . 105
5.5 Web App Interface #2 : Login Page . . . . . . . . . . . . . . . . . . . . . . 105
5.6 Web App Interface #3 : Administrators’ Dashboard . . . . . . . . . . . . . 105
5.7 Web App Interface #4 : Permissions and Roles Configuration. . . . . . . . 106
5.8 Web App Interface #5 : Permissions and Roles Synchronisation. . . . . . . 106
5.9 Web App Interface #6 : Healthcare Management. . . . . . . . . . . . . . . 107
5.10 Web App Interface #7 : Patient Management . . . . . . . . . . . . . . . . 107
5.11 Web App Interface #8 : Patient’s Health Card Information. . . . . . . . . 107
5.12 Mobile App Interface #1 : Welcome Page. . . . . . . . . . . . . . . . . . . 108
5.13 Mobile App Interface #2 : Connexion Page #1. . . . . . . . . . . . . . . . 109
5.14 Mobile App Interface #3 : Connexion Page #2. . . . . . . . . . . . . . . . 110
5.15 Mobile App Interface #4 : Home page. . . . . . . . . . . . . . . . . . . . . 111
5.16 Mobile App Interface #5 : Discussion page. . . . . . . . . . . . . . . . . . 112

A.1 Mohamed Diop’s Internship report. . . . . . . . . . . . . . . . . . . . . . . 116

A.2 Kheir Eddine Chebicheb’s Internship report #1. . . . . . . . . . . . . . . . 117
A.3 Kheir Eddine Chebicheb’s Internship report #2. . . . . . . . . . . . . . . . 118

15
List of Tables

2.1 Characteristics of DEM DZ. . . . . . . . . . . . . . . . . . . . . . . . . . . 36

2.2 Characteristics of PharmNET. . . . . . . . . . . . . . . . . . . . . . . . . . 37
2.3 Characteristic of Sante-dz . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
2.4 Characteristics of Updox . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
2.5 Characteristics of RayScan . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
2.6 Characteristics of Doctolib . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
2.7 Characteristics of Drugs.com . . . . . . . . . . . . . . . . . . . . . . . . . . 44
2.8 Characteristics of OpenFDA . . . . . . . . . . . . . . . . . . . . . . . . . . 45
2.9 Characteristics of Ada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
2.10 DEM DZ evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
2.11 Pharm’Net evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
2.12 Sante-dz evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
2.13 Updox evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
2.14 Doctolib evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
2.15 Drugs.com evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
2.16 Ada evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
2.17 Comparison table. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

5.1 Performance of the fine-tuned BioBERT model on the NER task . . . . . . 104
5.2 Additional performance of the fine-tuned BioBERT model on the NER task 104

16
List of Acronyms

AI Artificial Intelligence

API Application Programming Interface

BERT Bidirectional Encoder Representations from Transformers

BioBERT Bidirectional Encoder Representations from Transformers for Biomedical

Text Mining

BMC Business Model Canvas

CBCT Cone Beam Computed Tomography

CDSS Clinical Decision Support System

CIS Clinic Information System

DICOM Digital Imaging and Communications in Medicine

EHR Electronic Health Record

EMR Electronic Medical Record

FG-AI4H Focus Group on ”Artificial Intelligence for Health”

FHIR Fast Healthcare Interoperability Resources

GPT Generative Pre-trained Transformer

HIS Health Information System

HL7 Health Level Seven

HoIS Hospital Information System

HTTP HyperText Transfer Protocol

HTTPS Secure HyperText Transfer Protocol

ICT Information and Communication Technologies

IDE Integrated Development Environment

IP Internet Protocol

ITU International Telecommunication Union

JSON JavaScript Object Notation

17
LIS Laboratory Information System

MVC Model View Controller

NLP Natural Language Processing

NER Named Entity Recognition

NHIS National Health Information System

NoSQL Not Only SQL

OHIR Online Health Information Resources

OLED Organic light-emitting diode

PACS Picture Archiving and Communication System

PIS Pharmacy Information System

PMR Patient’s Medical Record

QA Question Answering

RE Relation Extraction

RIS Radiology Information System

SOAP Simple Object Access Protocol

STS Socio-Technical System

TCP Transmission Control Protocol

UCD Use Case Diagram

UX User Experience

UI User Interface

UML Unified Modeling Language

WCAG Web Content Accessibility Guidelines

WHO World Health Organization

W3C World Wide Web Consortium

XML Extensible Markup Language

18
General Introduction

19
General Introduction

Study Context
Efficient and effective collaboration between the patient and their medical environment
as well as inter-professional cooperation are essential to ensure quality care. The reduction
of information and knowledge asymmetry between patients and health professionals has
contributed to the development of what is called ”health democracy”[8] a term that
appeared in the 1990s in a French law aimed at strengthening the participation of citizens,
patients, and their representatives in health-related decision-making processes. The status
of the patient is evolving towards a so-called ”contemporary” patient, meaning a patient
who can be an ”actor,” ”informed,” ”expert,” ”partner,” or ”autonomous” depending on
the context[8, 9]. With the advent of ICT and its full development in the early 2000s,
particularly through the Internet, many digital platforms were born to facilitate these
interactions[10].

Problem Statement
In Algeria, the digitization of healthcare services is receiving considerable attention from
authorities, as evidenced by recent decrees on the subject [11]. Although this process has
already been initiated, there remain challenges in terms of communication, centralization
of healthcare services, patient empowerment, medical data management, care coordina-
tion, and adaptation to new technologies, particularly AI.

Objectives
In this context, the main objective of this project is to develop an innovative platform,
integrated into the Algerian National Health Information System (NHIS), which enhances
these aspects by enabling a rich, smooth, and secure interaction between patients and
healthcare professionals. It is accompanied by these more specific objectives :

• Manage Electronic Medical Records (EMRs): Create a centralized and secure

system for managing medical records accessible by both patients and healthcare
professionals.

• Integration with medical devices : Facilitate the integration of medical devices

through interfacing technologies (HL7, DICOM).

• Integration with AI: Integrate new AI technologies particularly Natural Lan-

guage Processing (NLP) to provide a tool for checking medication interactions with
recommendations and a chat bot assistant dedicated to patient information.

20
 • Ensure Telemedicine: Adoption of the 5 acts of Telemedicine (teleconsultation,
tele-expertise, medical teleassistance, medical telemonitoring, regulation).

• National Health Identification System: Digital medical card to identify pa-

tients and prevent certain emergency situations.

Methodology
To achieve this objective, we will use Scrum methodology, a widely recognized agile
approach known for its flexibility and efficiency. Scrum was designed to increase speed
of development, align individual and organization’s mottos, define a culture focusing on
performance, support shareholder value creation, to have good communication of perfor-
mance at all levels, and improve individual development and quality of life [12].

Thus, its numerous advantages justify our choice of this approach, as it promotes better
communication within the team and especially allows for early detection and resolution
of problems during the development stage.

Structure of the Thesis

This thesis is structured into 6 chapters as follows:

• Chapter 1 ”E-Health and the Patient”: In this chapter, we will present a

general overview of e-health, its impact on current healthcare systems, and its effect
on patient engagement in their own care process.

• Chapter 2 ”Literature Review”: This chapter includes a concise state-of-the-

art review related to our study context. We will highlight key platforms in this area,
their strengths and limitations, to classify them according to how well they meet
our objectives.

• Chapter 3 ”Requirements Specification”: As the name suggests, we will spec-

ify all the requirements (functional, non-functional, and technical) needed to achieve
our objectives, describing the functionalities, the main actors of our system, and use
case diagrams showing their intrinsic interactions.

• Chapter 4 ”Analysis and Design”: In this chapter, we will conduct an architec-

tural and detailed analysis of the final system, presenting its architecture, class and
component diagrams, sequence and activity diagrams for some key functionalities,
and the deployment diagram.

• Chapter 5 ”Realization”: In this chapter, we will indicate and justify the tech-
nical and technological choices for system implementation and present the main
resulting interfaces.

• Chapter 6 ”Conclusion”: Finally, this chapter includes a summary of the work

we have done, the limitations and obstacles we faced, presenting the perspectives
and a general conclusion.

21
 Chapter 1
E-Health and the Patient

22
Chapter 1

E-Health and the Patient

Introduction
This chapter explores the impact of e-health on patients; we will examine how e-health
improves access to care, the quality of medical services, and patient engagement in man-
aging their health. This chapter will also define key terms such as e-health, telemedicine,
Health Information System (HIS) and types of PMR to provide a clear framework for
subsequent discussions.

1.1 E-Health
At the end of the 1990s, the term e-health appeared for the first time in an article named
”What is e-health” as being ”an emerging field in the intersection of medical informatics,
public health and business, referring to health services and information delivered or en-
hanced through the Internet and related technologies” [13]. In the same article, researcher
Gunther Eysenbach characterizes it as ”The 10 e’s in e-health” namely:
• ”Efficiency”: Increasing the efficiency of care to reduce costs, notably by reducing
redundant medical procedures through enhanced communication among stakehold-
ers in the care process.

• ”Enhancing quality”: Enhancing the quality of care, which results from increased
efficiency by ”directing patient streams to the best quality providers”[13].

• ”Evidence based”: In the medical field, which is highly critical in terms of patient
life, the effectiveness and efficiency of interventions should be proven rather than
assumed, especially through scientific approaches.

• ”Empowerment”: Empowering patients and consumers to reduce information and

knowledge asymmetry between them and healthcare providers [8] by ”giving them
access to medical knowledge bases and personal electronic records via the internet”
[13].

• ”Encouragement”: ”Encouragement of a new relationship between the patient

and health professional, towards a true partnership, where decisions are made in a
shared manner” [13].

• ”Education”: ”Education of physicians through online sources (continuing medical

education) and consumers (health education, tailored preventive information for
consumers)” [13]

23
 • ”Enabling”: ”Enabling information exchange and communication in a standard-
ized way between health care establishments” [13] notably through standard conven-
tions such as Health Level Seven (HL7) and Digital Imaging and Communications
in Medicine (DICOM).

• ”Extending”: ”E-health enables consumers to easily obtain health services online

from global providers” [13], this would indeed allow the expansion of medical action
across a wide geographical area.

• ”Ethics”: Ethics is common to all sectors of activity, and the medical sector is no
exception. Interaction between healthcare providers and patients must be conducted
with the utmost respect for ethical standards such as ”online professional practice,
informed consent, privacy and equity issues” [13].

• ”Equity”: Equity is a multidimensional concept that applies to several areas, no-

tably health and access to healthcare. ”Health equity means that everyone has a fair
and just opportunity to be as healthy as possible. Achieving this requires remov-
ing obstacles to health—such as poverty and discrimination and their consequences,
which include powerlessness and lack of access to good jobs with fair pay; qual-
ity education, housing, and health care; and safe environments” [14]. The concept
encompasses societal, environmental, financial, ethnic, and cultural dimensions, as
well as aspects related to gender and age.

Since then, several studies have been conducted in the field of e-health [15]. Further-
more, on Google Scholar, the article ”What is e-health?” by Gunther Eysenbach [16] has
been cited approximately ”4678” times since its first publication.

E-health encompasses a wide range of areas where ICTs are used to support health-
care. This includes HIS that enable the collection, storage, processing, and distribution
of relevant health information for individuals, communities, or populations, a domain fo-
cusing on remote care: telehealth, and also an emerging field in recent years: artificial
intelligence in healthcare and robotic [2, 4, 1].

The figure 1.1 illustrates different components within e-health.

1.1.1 Telehealth
With the increase in the elderly population, lifestyle changes leading to a rise in chronic
diseases, and the need to improve the quality of care while considering limited financial
resources [17, 18], a new challenge arose in the medical field: home healthcare by using
ICTs was the appropriate response [19]. Although the terms telehealth and telemedicine
are used interchangeably [20, 21], their definitions differ. Telehealth is defined as the
”delivery of healthcare services when patients and providers are separated by distance”
[22]. According to the World Health Organization (WHO), it is the use of ”ICT for the
exchange of information for the diagnosis and treatment of diseases and injuries, research
and evaluation, and for the continuing education of health professionals” [22]. Thus,
telehealth involves remote care services (telemedicine) and encompasses all means for
training and informing various healthcare stakeholders.

24
Figure 1.1: Diagram illustrating the different components of e-health. Adapted from [1, 2]

1.1.1.1 Telemedecine
As mentioned above, many definitions add to the confusion surrounding telemedicine.
Indeed, most definitions consider telemedicine and telehealth as exactly synonymous[23].
However, telemedicine is a subset of telehealth that focuses solely on the provision of
medical services remotely. The prefix ”tele” conveys this image [24] and is applied to all
sub-domains, including :

• teleconsultation : which allows patients to consult healthcare professionals re-

motely through real-time communication technologies.

• telemonitoring : allowing for monitoring the medical condition of a patient.

• teleassistance : enabling healthcare professionals to provide remote assistance to

patients or other healthcare professionals.

• teleexpertise : which allows a healthcare professional to seek the opinion of other

healthcare professionals.

• regulation : management of emergencies and coordination of interventions in re-

sponse to them.

To this list is added telesurgery, an emerging sub-domain using robotic technologies and
wireless networks to conduct surgical operations remotely [25, 26].

1.1.1.2 M-health
”M-health,” or mobile health, is a field within e-health, sometimes complementary to
telemedicine, which utilizes mobile technologies (smartphones, tablets, etc.) in the realm
of healthcare [27]. The acceptance of mobile users through the democratization of mobile
technologies has allowed this field to experience considerable success [28, 29]. Indeed,
according to ”What’s the Big Data,” there are nearly 6.9 billion smartphone users as of

25
early 2024, representing 85% of the global population [30]. Furthermore, with the advent
of 5G and the latest wireless connection technologies offering high-speed transmission and
low latency [31], the use of wearable devices is becoming increasingly prevalent as they
can ”provide real-time feedback regarding a person’s health conditions” [32].

Used in teleconsultation, telemonitoring, teleassistance, and even teleexpertise, m-

health contributes to resolving telemedicine’s challenge regarding the connection between
patients, healthcare professionals, and the professionals themselves [18].

1.1.2 Medical Record

The earliest traces of medical records date back to antiquity, defined as a set of infor-
mation that allows knowing ”who the patient is and who provided health care,” ”what,
when, why and how services were provided,” and ”the outcome of care and treatment”
[33, 34]. Nowadays, in the digital age, the patient’s medical record has inevitably tran-
sitioned from paper to digital, a shift that has proven to be very beneficial in managing
the patient’s medical record [35].

1.1.2.1 Electronic Health Record / Electronic Medical Record

Although the terms Electronic Health Record (EHR) and Electronic Medical Record
(EMR) are used interchangeably (in the article [35]), they differ in their scope of use. Both
are legal medical records created in the healthcare setting that ”reduce medical errors by
utilizing computerized prescription entry, predicting drug interactions and displaying a
warning for the health-care provider, assisting clinicians in reconciling patient medications,
and most important, maintaining a detailed and legible medical record” [36]. The EMR
is more specifically used in clinics and ambulatory settings, whereas the EHR is more
comprehensive and used throughout the entire care process [37]. The EHR consists of
multiple EMRs.

1.1.2.2 Advantages of EHR/EMR Management Systems

EHR/EMR Management Systems help to provide a consolidated view of medical records
by enabling the integration of various Health Information Systems (HISs) such as Hospital
Information Systems (HoISs). As a result, EHR Management Systems plays an important
role in providing better healthcare services [38].

1.1.3 Health Information System

For effective care, we need good management, and the flow of information at every
point influences optimal management [39]. To achieve this, the inevitable solution was
the adoption of system enabling this flow: Health Information System (HIS) [40]. HIS is
defined as ”a set of components and procedures organized with the objective of generating
information which will improve health care management decisions at all levels of the health
system” [39]. HIS is composed of several subsystems that manage specific institutions
within the healthcare domain alongside the patient’s EHR.

26
1.1.3.1 Hospital Information System (HoIS)
With the definition provided of the HIS above, the HoIS (not exempt from this definition
rule) is defined as a Socio-Technical System (STS)1 of the hospital comprising all processes
of treatment of health information as well as the actors included in this process [41].

As mentioned in an article [42], the HoIS is composed of two or more of these subsys-
tems:

• Picture Archiving and Communication System (PACS): it ”includes several

subsystems and components: image acquisition devices, a data management system,
data storage de-vices, a transmission network, image display stations, and devices
to produce hard-copy images.”[43]

• Radiology Information System (RIS): for managing radiology services (billing,

appointments, etc.).

• Clinic Information System (CIS): for managing critical clinical information in

the care process.

• Pharmacy Information System (PIS): manages pharmacy services by provid-

ing features for checking drug interactions, allergies, etc., to assist in decision-making
and prevent any errors in medication prescription.

• Laboratory Information System (LIS): is ”a software-based laboratory and

information management system that offers a set of key features that support a
modern laboratory’s operations” [42].

• Clinical Decision Support System (CDSS): ”is intended to improve healthcare

delivery by enhancing medical decisions with targeted clinical knowledge, patient
information, and other health information” [3]. The figure 1.2 illustrates the diagram
of key interactions in knowledge-based and non-knowledge based CDSS.
1
STS in organizational development is an approach to complex organizational work design that rec-
ognizes the interaction between people and technology in workplaces

27
Figure 1.2: Diagram of key interactions in knowledge-based and non-knowledge based
CDSS. From [3]

1.1.3.2 Online Health Information Resources (OHIR)

The creation, sharing, and consumption of information have become easier through
interactive and collaborative web applications [44], especially if they are credible [45].
OHIR are systems using the Internet to convey health information among various health
domain users. This facilitates information dissemination and education. In a study on
online health information-seeking behavior based on 483 questionnaires [46], it was found
that nearly ”Seventy-five percent of the health information consumers believed the ob-
tained online health information had either a minor or major impact on them (or their
families and friends) in their health treatment decision making, overall health maintaining
approach, and the way the health information consumers thought about health-related
issues” [47].

They present themselves as a database and logic server for services in the health domain:
BMI calculator, drug interaction checker, health news, etc., accessible through access
interfaces such as web and mobile applications, APIs, etc. Figure 1.3 illustrates the
structure of OHIR.

28
 Figure 1.3: Structure of OHIR.

1.1.3.3 National Health Information System (NHIS)

NHIS is the organized and integrated network of resources and processes that contribute
to the overall production and communication of nationwide health-related information.

1.1.4 AI and Robotic in Healthcare

As the physical world becomes more digital, computing becomes increasingly prevalent
in all domains. Indeed, the digitization of physical health information has allowed subfields
of computer science such as AI and robotics to be applied effectively.

1.1.4.1 AI for Health

The emergence of AI with the application of new deep learning algorithms has allowed
machines to achieve what is known as ”human-level” performance in solving various tasks
across different domains. In this regard, the International Telecommunication Union
(ITU), in collaboration with the WHO, has established the Focus Group on ”Artificial
Intelligence for Health” (FG-AI4H) to promote the use of AI in the healthcare domain.
Most recent research in this field applied to healthcare has been directed towards medical
image recognition, potentially for classification, segmentation, and analysis, as well as
Natural Language Processing (NLP), leading to the development of health chatbots [4, 48].

Although the emergence of this field is impressive, it faces numerous challenges regard-
ing the interpretation and explanation of deep learning models, which is crucial because
”health data are sensitive and subject to privacy laws” [4, 49].

29
Figure 1.4: Mapping input data to diagnosis and treatment decision. Adapted from [4]

1.1.4.2 Healthcare Robotics

Medical robotics, sometimes complementary to AI in healthcare, refers to the use of
autonomous and supervised robotic technologies for ”physical and cognitive rehabilitation,
surgery, telemedicine, drug delivery, and patient management” . There are three main
categories of robots used in the healthcare sector: ”inside the body,” ”on the body,” and
”outside the body.” The three main direct users of these robots are: ”direct robots users,”
who are typically patients using all categories of robots, ”clinicians,” and ”caregivers,”
who use the ”outside the body” category [50].

1.2 From Passive Patient to Autonomous Patient

Recently, patient involvement in their own care process has become increasingly de-
manded in decision-making, shifting the patient from a passive position (no involvement,
dependency) to an active position (autonomy, shared decision-making) [51, 52].
While patient independence is highly encouraged, the relationship between the patient
and the professional should not be overlooked, as the patient is not alone in this process
[53]. This patient-professional interaction has become even easier with the use of ICT.

1.2.1 E-Patient
”A patient is a physical person receiving medical attention or care” is the definition
of the term patient according to Wikipedia. Variants of the term have been used since
antiquity to refer to ”one who suffers” [54]. Technically, every human at some point in
their life becomes a patient. In the past, the patient occupied a status of ”care object,”
but recent epidemic crises have mobilized several associations, advocating for a status of
”rights-bearing subject.” Nowadays, the patient wants to be informed about their illness.
Additionally, the emergence of ICT, affecting almost all domains and not sparing the
patient, has allowed easy access to their technical information [55, 8, 9]. We now refer to
the patient as a connected patient or an e-patient. Invented in the 1980s by Tom Fer-
guson, the term e-patient describes ”individuals who are equipped, enabled, empowered,
and engaged in their health and healthcare decisions” [56, 57].

30
1.2.2 Patient-Professional Relationships
The existence of healthcare professionals is the first proof that the patient is not alone
in their care process. In this process, a good relationship between patients and healthcare
professionals facilitates interactions, thereby improving the quality of care. In an interdis-
ciplinary collaborative context, stakeholders (patients and professionals) must maintain
an ethic of interdependence, flexibility, collective ownership of goals, collaborative act and
reflection on process [58].

• Interdependence: Time spent together, oral or written exchange, intrinsic respect

for each stakeholder’s opinions and contributions;

• Flexibility: Stakeholders must be able to face changes, whether planned or un-

planned, and demonstrate adaptability;

• Collective Ownership of Goals: Each stakeholder must take and understand

their responsibilities regarding their role in the care process to achieve the common
goal;

• Collaborative Act: Stakeholders must be aware of the importance of their collab-

oration to accomplish tasks they cannot do independently;

• Reflection on Process: Stakeholders must communicate to decide on the care

process and provide feedback to improve the collaborative relationship and effec-
tiveness.

1.2.3 Patient Empowerment

Empowerment, which emerged in the 1970s following socio-political movements and
refers to the action of giving power, was initially used to break the paternalistic, hierar-
chical, and unequal status [59]. When applied to the patient, the term refers to giving the
patient the power to act in their own care process. Most of the application of this notion
in the medical context emphasized ”participative strategies” [8] for the patient. Further-
more, as the patient becomes increasingly an e-patient, researchers [60] have analyzed the
social uses of ICTs for patient empowerment, including:

• ”Consulting health information online”;

• ”Online drug purchases”;

• ”Telehomecare”;

• ”Electronic Health Records”.

Thus, to empower the patient, it is essential to consider their information and education
to reduce the information and knowledge asymmetry compared to healthcare profession-
als. This includes providing them with complete access to their medical records and all
medical information concerning them, enabling them to be autonomous, strengthening
their engagement and collaboration, and becoming partners in decision-making regarding
their medical condition.

31
1.2.4 The Patient Acceptance Challenge
Although patient empowerment through ICT is an innovative solution in managing
their care process, several acceptance factors come into play, such as social factors, socio-
demographic factors, and factors related to the quality of the technology in question.

”Technologies cannot help facilitate self-monitoring and self-management

or improve patients’ health outcomes when patients do not accept
the technology”

Calvin K.L. Or and Ben-Tzion Karsh

Conclusion
In conclusion, e-health represents a major transformation in the way healthcare man-
agement is implemented by professionals and perceived by patients. HIS combined with
ICT have provided easy access to information, enabling active involvement and autonomy
for patients in their care process and fostering effective collaboration between healthcare
professionals and patients. However, the acceptance of these technologies depends on
numerous factors, including social factors, socio-demographic factors, and factors related
to their quality. By overcoming these challenges, e-health can significantly improve the
patient experience and the quality of care.

After presenting the impact of e-health on the medical field and the patient, the next
chapter entitled ”Literature Review” and in addition to this chapter, will provide a syn-
thesis of key research and platforms related to our project by presenting their strengths
and weaknesses.

32
 Chapter 2
Literature Review

33
Chapter 2

Literature Review

Introduction
The field of e-health being constantly evolving, it is essential to be aware of the current
advances, trends, and challenges to better guide and contextualize our work. In this
chapter of literature review or state of the art, we will present related works to our study
context, focusing in particular on validation criteria that we will define beforehand to
highlight the shortcomings associated with these works and their influence on the design
of our system. We will also present the adopted methodology and the types of research
activities conducted.

2.1 Research Methodology

During the literature review period, we conducted numerous searches supported by
literature review internships during which we were able to interact directly with some of
the key platforms related to our study context. We supplemented these searches with
internet searches and bibliographic searches in online databases and surveys with various
stakeholders in the healthcare field.

2.1.1 Literature review internships

From 2024-02-02 to 2024-03-31, we conducted literature review internships at the
”Établissment Public de Santé de Proximité - Tiaret”, ”Établissment Public de Santé
de Proximité - Ain Kermes” and ”Centre de Diagnostic Medical EL AMAL- Tiaret” as
part of a review on existing current solutions (refer to 6). Our research was supervised by
highly competent staff in their field who provided us with all the necessary information
regarding the subject matter. During these internships, we were able to directly interact
with two of the most used e-health platforms in Algeria: DEM DZ and RayScan. In the
”Related Work” section, we will provide a brief presentation of these platforms.

2.1.2 Online Databases

In addition to our literature review internships, we conducted in-depth research on
more theoretical topics using various databases of articles and scientific publications and
Internet. We specifically looked at :
• Google Scholar;
• Cairn;

34
 • ResearchGate;

• ScienceDirect

• and Érudit.

2.1.3 Market Study

To support the literature review and prepare us for the specification of requirements, we
conducted surveys both in-person and online using tools like Google Forms. This allowed
us to collect additional information beyond what was gathered during our literature review
internships. We will also present these results in a summarized form in the requirements
specification section.

2.2 Related Works

In this section, we will first present the various platforms and key works related to our
study context in Algeria and globally. Then, we will provide a critical synthesis of these
platforms.

2.2.1 Related Platforms

Numerous platforms and systems have emerged following the digital democratization
in the healthcare sector. Most of them facilitate health-related research (news, medica-
tions, etc.), while others are used for managing EHR and healthcare facilities. We used
information such as the name, type of platform, creation date, developer, access website
(if available), platform accessibility (whether access is free or subject to certain condi-
tions), type of HIS used, and the main features offered to primary users to highlight the
characteristics of the various platforms we studied in our research. A table containing
these characteristics will be presented for this purpose.

2.2.1.1 DEM DZ
DEM DZ, analogous to ”Dossier Électronique Médical Algérien”, is a locally integrated
web platform within public healthcare facilities in Algeria. It manages local patients’
EHR and queues to ensure the provision of medical services, improves patient reception
conditions, and guides them based on the specific needs of each case. During our in-
ternships at the EPSP-Tiaret, we were able to interact with this platform in a patient
admission scenario. The figure 2.1 illustrates the dashboard in DEM DZ, where statistics
on patient flow and the number of personnel in the facility can be seen.

35
 Figure 2.1: DEM DZ Dashboard

The table 2.1 below presents the characteristics of DEM DZ.

DEM dz
Platform Type Web / Mobile (Incomplete Version)
Creation Date 2017
Information System HIS
Geographic Area Algeria
Developer Ministry of Health (Information System and Computer
Directorate)
Access Restricted (Public healthcare facilities only)
Features for Practition- Authentication
ers Bed Management
Admission Management (patients)
Management of visits, procedures, and medical prescrip-
tions
Terminal Management - advanced functionality (TV,
tickets, etc.)
Features for Patients History of his visits
Get a medical record.

Table 2.1: Characteristics of DEM DZ.

2.2.1.2 Pharm’Net
Pharm’Net is an Algerian web application that follows the official nomenclature of
medications used in Algeria, allowing users to consult package inserts, view equivalents,
and drug interactions, as well as other characteristics[61]. The figure 2.2 illustrates the
Pharm’Net website home page.

36
 Figure 2.2: Pharm’Net website.

The table 2.2 below presents the characteristics of Pharm’Net.

Pharm’Net
Platform Type Web
Website Address http://www.pharmnet-dz.com/
Creation Date 2018
Information System CDSS / OHIR
Geographic Area Algeria
Developer ESAHTI Sarl
Access Free (limited) / Paid (all access subscription-based)
Features for Practition- Authentication;
ers Access to medication information (package inserts, in-
teractions, etc.);
Supervised prescription ordering (verification of drug in-
teractions)

Table 2.2: Characteristics of PharmNET.

2.2.1.3 Sante-dz
Sante-dz is a set of informative guide platforms in the field of healthcare in Algeria.
Among other things, it provides a directory of various healthcare professionals, advice on
human health, and upcoming events in the healthcare domain.
It is divided into four major main platforms, three of which are functional:
• santedz
This platform, accessible via the link https://www.sante-dz.com/, is the main
platform of the company. It provides useful information on human health with a
news system. The figure 2.3 illustrates santedz website.

37
 Figure 2.3: santedz website.

• annumed
This platform, accessible via the link https://annumed.sante-dz.com/, provides
a directory of healthcare professionals, along with its search system (by name, by
locality). The figure 2.4 illustrates the annumed website.

Figure 2.4: annumed website.

• eventmed
This platform, accessible via the link https://eventmed.sante-dz.com/, provides
an overview of upcoming events in the medical field. The figure 2.5 illustrates the
eventmed website.

38
 Figure 2.5: eventmed website

• noncemed
This platform is intended to publish announcements in the medical field, but it is
not functional at the moment. It is an advertising platform (possibly a source of
revenue in their business model.

The table 2.3 below presents the characteristics of Sante-dz.

Sante-dz
Platform Type Web
Creation Date 2006
Site Address https://www.sante-dz.com/
Information System OHIR
Geographic Area Algeria
Developer Softart-dz
Access Free / Paid (Access to exclusive content)
Features for Practition- Authentication;
ers Access to information regarding announcements, events,
and health.
Features for Patients Authentication;
Access to a directory of doctors with the ability to sched-
ule an appointment (contact establishment)

Table 2.3: Characteristic of Sante-dz

2.2.1.4 Updox
Updox is a comprehensive healthcare communication platform designed to stream-
line administrative tasks, improve patient engagement, and enhance collaboration among

39
healthcare providers. It offers a range of features and services tailored to the needs of
healthcare practice by a variety of software. The figure 2.6 illustrates an overview of
Updox platform.

Figure 2.6: Updox overview from [5].

The table 2.4 below presents the characteristics of Updox.

Updox
Platform Type Web / Desktop Software
Site Address https://www.updox.com/
Creation Date 2008
Information System HIS
Geographic Area United States
Developer Updox LLC
Access Paid (based on the needs of the client company)
Features for Practition- Direct Secure Messaging
ers and Patients Telehealth Service Integration
Appointment Reminders
Patient Portal
Broadcast Messaging
e-Form
e-Fax
Secure Messaging

Table 2.4: Characteristics of Updox

2.2.1.5 RayScan
2.2.1.5.1 During our internships at the ”Centre De Diagnostic Medical EL AMAL
- Tiaret,” we were able to interact with RayScan and the software used to operate it.
RayScan is a Cone Beam Computed Tomography (CBCT)1 system developed by the
South Korean company Ray Co., provided through four series: s, α+, α, and m+. The
system integrates with a SIR to transmit radiological data. The figure 2.7 illustrates the
software used to manipulate RayScan.
1
CBCT is a three-dimensional medical imaging technique based on the numerical analysis of the
absorption of a cone beam of X-rays and particularly suitable for exploring the dento-maxillary system

40
 Figure 2.7: RayScan Manipulation Software

The table 2.5 below presents the characteristics of RayScan.

RayScan
Platform Type Hardware and Software System
Creation Date n.d
Information System RIS
Geographic Area Global
Developer Ray Co.
Access Paid (Equipment purchase)
Features for Practition- Acquisition, storage, archiving, interpretation, and di-
ers agnosis of radiological images;
Integration of a Radiology Information System;
Interface with other information systems for data trans-
fer

Table 2.5: Characteristics of RayScan

2.2.1.6 Doctolib
Doctolib is a French company offering web-based software solutions for healthcare pro-
fessionals and a mobile service for online appointment booking for patients. Figures
2.8 and 2.9 illustrate an overview of the Doctolib mobile application and the website
https://doctolib.fr, respectively[62].

41
 Figure 2.8: Doctolib Mobile Application.

Figure 2.9: Doctolib Website.

The table 2.6 below presents the characteristics of Doctolib platforms.

42
 Doctolib
Platform Type Web / Mobile
Site Address https://www.doctolib.fr/
Creation Date 2013
Information System France
Geographic Area France, Germany, Italia and Nederland
Developer Doctolib Enterprise
Access Free
Features for patients Patient registration/login;
Search for a doctor;
Online appointment scheduling;
Video consultation with reimbursements;
Sharing prescriptions with pharmacies;
Medical record management
Features for Practition- Document management, patient records, etc.;
ers Appointment scheduling;
Online agenda for sharing prescriptions and documents;
Instant messaging for healthcare professionals;
Secure document sharing

Table 2.6: Characteristics of Doctolib

2.2.1.7 Drugs.com
Drugs.com is a Cross-Platform Service that provides independent medical information
in pharmaceutical services and Healthcare services to enhance, the information related
to medications, medical conditions, and healthcare topics. It offers a range of features
and services tailored to the needs of healthcare practices in this table. The figure 2.10
illustrates the Drugs.com website.

Figure 2.10: Drugs.com website.

The table 2.7 below presents the characteristics of Drugs.com.

43
 Drugs.com
Platform Type Web / Mobile
Website Address https://www.drugs.com/
Creation Date 1998
Information System OHIS / PIS
Geographic Area Global
Developer Karen Ann and Philip Thornton
Access Free
Features for Users Information about medications (package inserts, INN,
etc.);
Verification of drug interactions with recommendations;
Pharmaceutical news.

Table 2.7: Characteristics of Drugs.com

2.2.1.8 OpenFDA
OpenFDA is a research project aimed at providing open API, raw data downloads,
documentation, and examples, as well as a developer community for a large collection of
public FDA datasets [63]. Figures 2.11 and 2.12 respectively represent a response from
an endpoint of the OpenFDA API and statistics on the general usage of the API.

Figure 2.11: Response of GET https://api.fda.gov/drug/label.json?

44
 Figure 2.12: OpenFDA API calls statistics.

The table 2.8 below presents the characteristics of OpenFDA.

OpenFDA
Platform Type Web
Creation Date 2014
Information System OHIS / PIS
Geographic Area Global
Developer Food and Drug Administration (FDA)
Access Free (CC0-1.0 license)
Features for Internet Users API on information regarding drugs, medical
devices, food, and cosmetic products with its
documentation

Table 2.8: Characteristics of OpenFDA

2.2.1.9 Ada
Ada is a medical diagnostic application based on artificial intelligence, which assists
users in identifying possible causes of their symptoms and suggesting appropriate actions.
Figure 2.13 illustrates a symptom evaluation scenario in the Ada application.

45
 Figure 2.13: Symptom Evaluation in the Ada Application.

The table 2.9 bellow presents the characteristics of Ada.

Ada
Platform Type Mobile
Creation Date 2016
Information System CDSS
Geographic Area Global
Developer Ada Health
Access Free
Features for users Symptom Evaluation
Personalized Health Report
Consultation History
Access to Reliable Medical Information

Table 2.9: Characteristics of Ada.

2.2.2 Thematic Literature Review

As part of an in-depth investigation into topics such as the integration of different
components of a HIS and the use of NLP in healthcare, we conducted research to create
thematic literature reviews. In this section, we will provide a summary of these research
findings.

2.2.2.1 Integration in Healthcare

The emergence of new technologies in the medical field contributes significantly to the
creation of a heterogeneous ecosystem in healthcare. This is particularly manifested by
a technological inertia behavior among different stakeholders towards legacy systems -
obsolete technologies still in use due to the costs and efforts of change, as well as user
habituation - and the lack of adoption of a communication standard by developers of

46
new technologies [64, 65]. Integration is the translation of data across systems [66]. In
the ecosystem of a HIS, it is the key to its interoperability, enabling smooth, coherent,
and trouble-free communication, but its heterogeneity poses a challenge to achieving this.
Many research efforts aim to overcome this challenge. While some focus on adapting
legacy systems to new communication standards [65, 67], others seek to make legacy
systems self-adaptive to adapt to any changes in their ecosystem [68]. In 2023, the WHO
and the HL7 organization signed a collaboration agreement to support the adoption of
open interoperability standards globally [69]. There is no doubt that the concept of
interoperability is becoming essential in the healthcare domain.

HL7 standards for Interoperability

The HL7 organization is a nonprofit standards development organization that pro-

vides a comprehensive framework and related standards for the exchange, integration,
sharing, and retrieval of electronic health information that supports clinical practice
and the management, delivery, and evaluation of health services [70]. There are sev-
eral standards, with the most commonly used being version 2 (HL7 V2) and the more
modern HL7 Fast Healthcare Interoperability Resources (FHIR), which allows for the
use of Application Programming Interface (API) concepts for data exchange. The use of
HL7 standards varies depending on the standards and the functionality they offer, but in
general, programming languages such as Java, C++, Python, etc., are used to implement
HL7 standards, web services such as Simple Object Access Protocol (SOAP) and RESTful
web services for web-based information exchange, protocols such as Transmission Control
Protocol (TCP)/Internet Protocol (IP), HyperText Transfer Protocol (HTTP), Secure
HyperText Transfer Protocol (HTTPS), etc., for communication, and databases such as
MySQL, PostgreSQL, etc., for storing information. Pendant que les normes HL7 se basent
pratiquement dans l’échange d’information clinique et adminstrative d’autres normes sont
conçues pour l’échange des images médicales, on pense notamment à DICOM.

DICOM standard

The DICOM standard is a widely used communication standard in medical imaging

to ensure interoperability between medical devices and PACS. Nowadays, it is increasingly
difficult to find modern PACS systems that do not provide DICOM connectivity interfaces
for receiving images from medical procedures [71, 72]. However, DICOM does not define
a PACS or modify its structure; instead, it provides intermediary services between PACS
and medical components. The DICOM standard uses the TCP/IP protocol to define the
formats for medical images that can be exchanged with the necessary data and quality
for clinical use [71, 73].

2.2.2.2 NLP in Drug Interaction Checker and Medical Chatbot

Natural Language Processing (NLP) is a field of Artificial Intelligence (AI) that, as
its name suggests, is based on natural language processing. It is used for indexing and
searching large texts, information retrieval, classification of text into categories, infor-
mation extraction, automatic language translation, automatic summarization of texts,
question-answering, knowledge acquisition, and text generation/dialogues. NLP is used
in the medical domain ”to structure information in healthcare systems by extracting
relevant information from narrative texts to provide data for decision making” [74], par-
ticularly in medication prescribing. Indeed, NLP models are being developed to detect

47
drug interactions during the prescription of medications by healthcare professionals. We
are particularly thinking of BioBERT model.

BioBERT model for detecting drug interactions

BioBERT is a specialized version of the Bidirectional Encoder Representations from

Transformers (BERT) model that is trained on a vast corpus of biomedical texts, includ-
ing scientific articles, clinical databases, and research documents [6]. BioBERT inherits
all of BERT’s capabilities, already excelling in understanding the context of words in
both directions. Introduced in the context of biomedical text mining, BioBERT’s ap-
plication extends to the extraction, analysis, relationship recognition, and classification
of biomedical entities. Since drugs are part of these entities, BioBERT is particularly
useful in detecting drug interactions—adverse events to drugs ”that are noxious, un-
intended, and occur at doses normally used in man” [75, 76]. Already pre-trained on a
large biomedical corpus, the BioBERT model is then fine-tuned2 to perform Named Entity
Recognition (NER), Relation Extraction (RE), and Question Answering (QA). Figure
2.14 illustrates the three tasks that the fine-tuned BioBERT model can accomplish.

Figure 2.14: Fine-tuning of BioBERT. From [6]

Thus, these three tasks allow us to:

• NER: Identify the names of drugs, diseases, treatments, and other biomedical enti-
ties in research articles.

• RE: Detect interactions between drugs, causal relationships between symptoms and
diseases, or side effects of treatments.

• QA: Answer clinical questions posed by healthcare professionals or patients using

medical databases or scientific publications.
2
Fine-tuning a model refers to the process of taking a pre-trained model and making small adjustments
to it in order to adapt it to a specific task or dataset

48
 Medical Chatbot

With the recent emergence of Natural Language Processing (NLP) language models
such as Generative Pre-trained Transformer (GPT), Bidirectional Encoder Representa-
tions from Transformers (BERT), etc., AI is becoming increasingly prevalent in content
generation (text, image, sound), search optimization, etc. Chatbots, born from this emer-
gence due to AI’s understanding of human language, are autonomous systems that can
memorize conversational flows to become more proficient in responses. Many initially
dismissed mild symptoms have serious consequences, often due to the reluctance of symp-
tomatic individuals to visit a doctor. To address this, seeking information on online health
forums is an effective means to motivate seeking medical consultation. However, the dif-
ficulty of obtaining an immediate response, the limited availability of experts to respond,
and the poor understanding of responses due to the use of technical terms are recurrent
issues in online symptom searching. Medical chatbots are practical solutions to these
problems [77, 78]. Indeed, thanks to their powerful understanding of human language,
they can interact with users and provide them with medical information, health advice,
or personalized assistance based on their symptoms, concerns, or questions.

2.2.3 Evaluation criteria

To classify and compare the related platforms presented above, we selected evaluation
criteria aligned with the objectives we aim to achieve regarding patient collaboration with
healthcare professionals through e-health platforms. Some criteria will be represented as
a percentage of their completion rate. Thus, we will sum up the achievement of these
criteria, which will be scored out of 6. We will provide a synthesis based on these criteria
in the section ”Synthesis and Critical Analysis.” These criteria are:

2.2.3.1 Collaboration
We chose this criterion to refer to whether the platforms have the capability to ensure
collaboration between patients and healthcare professionals, with the patient as an active
participant in the care process.

2.2.3.2 EHR Management

This criterion was chosen based on the ability to provide EHR management services.
Its effective value is 100% when the management is bidirectional (patient-professional).

2.2.3.3 Telemedicine
This criterion refers to the ability to support telemedicine activities, including telecon-
sultation, telemonitoring, teleassistance, teleexpertise, and regulation. Its value is 20%
per telemedicine activity.

2.2.3.4 Integrate to the Algerian NHIS

This criterion refers to the ability to integrate with the NHIS. This includes the use
of ICT such as cloud computing to ensure the availability of information nationwide. Its
value is 80% when the platform is integrated into the NHIS and 20% when the platform
uses the cloud. The effective value is the sum of both values.

49
2.2.3.5 Integration with medical devices
This criterion is the ability to integrate medical devices by providing connection inter-
faces with them.

2.2.3.6 Drug Interaction Checker

This criterion refers to the ability to provide drug interaction checking services.

2.2.3.7 Medical Chatbot

This criterion refers to the ability to provide medical chatbots to interact with users in
a medical context.

2.2.4 Synthesis and Critical Analysis

In this section, we will conduct a critical analysis of the mentioned platforms, high-
lighting their strengths and weaknesses. Subsequently, we will synthesize to evaluate how
this literature review contributes to the development of our project. Some related works,
such as RayScan and OpenFDA, are excluded because they have a score of 0 and are not
relevant to the comparison.

2.2.4.1 DEM DZ
DEM DZ is an Algerian platform integrated within public healthcare facilities. As im-
plied by its name, it facilitates the management of the patient’s EMR within the facility
and locally. Well-structured and designed for EMR management, it also provides services
for cooperation among healthcare professionals in the care process, including queue man-
agement, inter-professional patient flow, prescribed procedures, patient admissions and
discharges, and patient bed allocation. Although it is a powerful tool for healthcare pro-
fessionals, the platform’s localization to a single site prevents the sharing of EMR across
facilities, which could be a significant asset in tracking patient history. Additionally, the
platform does not provide a portal for patients to collaborate with professionals and em-
power themselves. The patient is treated as an object within the system rather than an
active participant. Table 2.10 below presents the evaluation of DEM DZ according to the
assessment criteria.

DEM DZ
Collaboration No collaboration with patient
Telemedicine 20% (Teleexpertise)
EHR Management Avalaible
Integrate to the Algerian NHIS 80%
Integration with medical devices Available
Drug Interaction Checker No Available
Medical Chatbot No Available
Score 3/7

Table 2.10: DEM DZ evaluation.

50
2.2.4.2 Pharm’Net
Pharm’Net is an Algerian platform that provides services related to medication prescrip-
tion. Originally designed as a tool for healthcare professionals, it offers e-prescription
functionalities and information about official medications used in Algeria (including a
drug interaction checker). However, access to the drug interaction checking feature is
paid (5000 DA/year according to their official website https://www.pharmnet-dz.com/
abonnement.aspx), whereas it is free on similar international platforms such as Drugs.com
and DrugBank. Table 2.11 below presents the evaluation of Pharm’Net according to the
assessment criteria.

Pharm’Net
Collaboration No collaboration with patient
Telemedicine 0%
EHR Management No Avalaible
Integrate to the Algerian NHIS No Integrated
Integration with medical devices No Available
Drug Interaction Checker Available (Paid)
Medical Chatbot No Available
Score 1/7

Table 2.11: Pharm’Net evaluation.

2.2.4.3 Sante-dz
The Sante-dz platforms collectively serve as both a directory of healthcare professionals,
a means of visibility for these professionals, and a repository of medical information. While
the platforms offer functionalities for connecting with healthcare professionals, notably
through the directory and discussion forums, these interactions are limited to informa-
tional purposes only. Table 2.12 below presents the evaluation of Sante-dz according to
the assessment criteria.

Sante-dz
Collaboration No collaboration with patient
Telemedicine 0%
EHR Management No Avalaible
Integrate to the Algerian NHIS 100%
Integration with medical devices No Available
Drug Interaction Checker No Available
Medical Chatbot No Available
Score 1/7

Table 2.12: Sante-dz evaluation.

2.2.4.4 Updox
The strength of Updox lies in its versatility in terms of functionalities. Indeed, it offers
a range of features designed for both healthcare professionals and patients. However,
access to these services is only available in the United States. Table 2.13 below presents
the evaluation of Updox according to the assessment criteria.

51
 Updox
Collaboration Available
Telemedicine 100%
EHR Management Avalaible
Integrate to the Algerian NHIS No Integrated
Integration with medical devices Available
Drug Interaction Checker Available
Medical Chatbot No Available
Score 5/7

Table 2.13: Updox evaluation.

2.2.4.5 Doctolib
The solutions provided by Doctolib are effective in allowing patients to manage their
EMR themselves. These solutions offer the possibility of teleconsultation and sharing
medical documents with healthcare professionals. Although anyone can use Doctolib,
healthcare professionals are only available in the accessible regions mentioned. Table 2.14
below presents the evaluation of Doctolib according to the assessment criteria.

Doctolib
Collaboration Available
Telemedicine 40% (Teleconsultation and Teleassistance)
EHR Management Avalaible
Integrate to the Algerian NHIS No Integrated
Integration with medical devices No Available
Drug Interaction Checker No Available
Medical Chatbot No Available
Score 3.4/7

Table 2.14: Doctolib evaluation.

2.2.4.6 Drugs.com
Drugs.com offers all the functionalities regarding drug information search and medica-
tion interaction checking. Being a CDSS and an OHIR, it remains a powerful tool for
internet users. Table 2.15 below presents the evaluation of Drugs.com according to the
assessment criteria.

Drugs.com
Collaboration No Available
Telemedicine 0%
EHR Management No Avalaible
Integrate to the Algerian NHIS No Integrated
Integration with medical devices No Available
Drug Interaction Checker Available
Medical Chatbot No Available
Score 1/7

Table 2.15: Drugs.com evaluation.

52
2.2.4.7 Ada
Ada is a CDSS that implements a chatbot to assess symptoms. This information can
be shared with healthcare professionals. Table 2.16 below presents the evaluation of
Drugs.com according to the assessment criteria.

Ada
Collaboration No Available
Telemedicine 0%
EHR Management No Avalaible
Integrate to the Algerian NHIS No Integrated
Integration with medical devices No Available
Drug Interaction Checker No Available
Medical Chatbot Available
Score 1/7

Table 2.16: Ada evaluation.

2.2.4.8 Synthesis and Comparison

The majority of the platforms mentioned above struggle to exceed the average score.
While all these platforms perform well in accomplishing their tasks, few ensure collabo-
ration between patients and healthcare professionals to enhance the quality of care. The
scores of the various platforms evaluate them relative to the state-of-the-art in our con-
text. Some manage to satisfy certain criteria while struggling to check the box for others.
Table 2.17 below illustrates the comparison between the scores of the different platforms.

Comparison between related platforms’ evaluation score

Updox 5
Doctolib 3.4
DEM DZ 3
Pharm’Net 1
Sante-dz 1
Ada 1
Drugs.com 1

Table 2.17: Comparison table.

2.3 Conclusion
In summary, this literature review has allowed us to highlight major developments
in the field of e-health in Algeria and worldwide. The key platforms studied within the
context of our research exhibit shortcomings in facilitating effective collaboration between
patients and healthcare professionals, despite their ability to efficiently accomplish tasks.
This enabled us to compare the current literature with the achievement of our objectives.

We have also shed light on current techniques used to ensure interoperability in the
healthcare domain. Among these techniques are medication interaction checking and
medical chatbots utilizing NLP, along with ensuring integration through standards such
as HL7 and DICOM, which play a crucial role in decision support, interoperability, and
patient empowerment.

53
 In conclusion, this review has provided us with the necessary foundation to understand
the current state of e-health and the associated challenges. The following chapters will be
motivated by achieving a score of 7/7 for our objectives. Armed with this comprehensive
understanding, we are now ready to delve into the specifications of requirements in the
next chapter titled ”Requirements Specification.”

54
 Chapter 3
Requirements Specification

55
Chapter 3

Requirements Specification

Introduction
In project development, the requirements specification phase is crucial. It is during this
phase that the expectations and needs of end users, as well as the technical and functional
constraints of the project, are clearly and precisely defined. In this chapter, we will explore
the needs expressed during surveys conducted as part of a market study, by the various
stakeholders we will identify beforehand. We will also present the methodology used and
the corresponding use case diagrams for each needs.

3.1 Market Study

As part of our market study aimed at understanding the trends and behaviors of dif-
ferent end users in the healthcare sector, we conducted face-to-face surveys during our
literature review stages, complemented by online surveys on a small sample. The sample
consisted of 51 individuals between the ages of 21 and 62, including both healthcare service
consumers and healthcare professionals. The surveys were conducted using questionnaires
that we prepared beforehand to better direct the responses towards our understanding
objectives. In this section, we will present the justification for choosing key questions,
an overview of the responses obtained, as well as some graphs from the online surveys
(conducted with Google Forms).

3.1.1 Key Questions and Answers

A well-posed question leads to a satisfactory answer in terms of understanding. The fol-
lowing list is a non-exhaustive list of key questions we prepared and the answers obtained,
these questions include:

3.1.1.1 Q1: ”Dans le cadre de la prévention d’un patient quelconque, quel

est le moyen de communiquer avec lui?”
Translation: As part of the prevention of any patient, what is the way to communicate
with him?

Purpose: We asked this question to healthcare professionals to know what means

they used to communicate with patients. The answers to this question will allow us to
understand the relationship patients maintain with professionals outside of healthcare
facilities.

56
 Answers: The majority of responses to this question were via ”telephone means”.
Indeed, professionals are used to using phone calls and messaging to deliver information
to patients.

3.1.1.2 Q2: ”Dans le cadre du transfert d’un patient dans votre établissement
ou la prise en charge d’un nouveau patient, avez-vous directement
accès à son dossier médical?”
Translation: When transferring a patient to your establishment or taking care of a
new patient, do you have direct access to their medical file?

Purpose: The purpose of this question was to find out if healthcare professionals
had access to patients’ medical history in the context of inter-establishment transfer or
admission.

Answers: The majority of responses were ”No”, but professionals stated that they
had a local medical file on the patient’s visits to their establishment, although a minority
responded that in the context of a transfer, the transferring center sent them the file, and
in the case of a new patient’s admission, they had to create a new medical file. Figure
3.1 illustrates the graph from the Google Forms sample responses.

Figure 3.1: Q2 Answers graphic.

3.1.1.3 Q3: ”Dans le cadre de la prise en charge d’un patient en urgence dont
vous ne pouvez pas déduire l’état général à cause des circonstances
d’absence d’accompagnateur fiable (proche), de l’impossibilité de com-
munication avec le patient à cause de son état d’urgence, ou bien
d’autres, comment traitez-vous ce cas?”
Translation: In the context of caring for an emergency patient whose general condition
you cannot deduce due to the circumstances of absence of a reliable (close) companion,
the impossibility of communication with the patient due to his state of emergency, or
many others, how do you handle this case?

Purpose: This question aims to highlight the need for healthcare professionals to
access medical history in emergency situations.

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 Answers: Although the patient’s health is important and every treatment is meticulous
in such conditions, the majority of professionals responded ”Blindly” to this question.
Some stated that a clinical examination was necessary, while others focused on eliminating
the emergency while waiting for reliable information, which can be damaging when time
is critical. Figure 3.2 illustrates the graph from the Google Forms sample responses.

Figure 3.2: Q3 Answers graphic.

3.1.1.4 Q4: ”Comment faites pour obtenir de l’information sur la santé?”

Translation: How do you get health information?

Purpose: This question aims to understand how healthcare service consumers obtain
health information.

Answers: The responses to this question were distributed, in terms of percentage,

between healthcare professionals’ demand and the use of the Internet (discussion forums,
informational websites, etc.) in two scenarios: in one, individuals stated that it was
convenient, but some noted the difficulty in obtaining the desired answers; in the other
case, seeking advice from relatives and using chatbots like ChatGPT, Ada, etc., were the
responses of a minority of them. Figure 3.3 illustrates the graph from the Google Forms
sample responses.

Figure 3.3: Q4 Answers graphic.

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3.1.1.5 Q5: ”Avez-vous déjà fait une analyse médicale (Radio, Écho, IRM,
Labo, etc.)? Si oui comment avez-vous fait pour récupérer les résultats?
Est-ce que cela a été pratique?”
Translation: Have you ever done a medical analysis (X-ray, Echo, MRI, Lab, etc.)?
If so, how did you go about getting the results? Was this practical?

Purpose: This question, particularly aimed at healthcare service consumers, aims to

understand the means used to obtain medical analysis results.

Answers: The majority of responses to this question likely indicated inconvenience

in obtaining results. While some said it was impractical, most of them claimed to have
adapted to this practice. Among the remaining responses, there was a minority who
had experienced sending results via telephone means, admitting it was convenient, while
others had never undergone medical tests. Figure 3.4 illustrates the graph from the Google
Forms sample responses.

Figure 3.4: Q5 Answers graphic.

3.1.1.6 Q6: ”Avez-vous déjà expérimenté une consultation médicale à dis-

tance? Si oui est-ce que cela a été pratique pour vous?”
Translation: Have you ever experienced a remote medical consultation? If so, was it
practical for you?

Purpose: This question aims to determine if telemedicine is trending among healthcare

service consumers.

Answers: The majority of individuals responded that they had never experienced
remote medical consultation, while a minority stated that they had. Some claimed it was
convenient, while others did not. Figure 3.5 illustrates the graph from the Google Forms
sample responses.

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 Figure 3.5: Q6 Answers graphic.

3.1.2 Synthesis and Conclusion

The market study allowed us to understand the current trends and needs expressed
by users in the healthcare field. The responses to the various questions will guide the
features offered by the system to satisfy these needs in terms of novelty and habituation.

3.1.2.1 Contribution of Responses to Requirements Specification

The responses to each question aim to specify a need such as:

• Q1: Ensure communication via telephone means (messaging, calls, etc.) between
healthcare professionals and patients.

• Q2 and Q3: Ensure access and management of the patient’s medical file regardless
of the transfer or admission establishment and the patient’s condition.

• Q4, Q5, and Q6: Ensure telehealth services such as information and education of
various actors in the healthcare field and telemedicine.

With this foundation, the identification of different actors in the future system, as
well as the functional and non-functional requirements it must meet, will be the subjects
of the next section.

3.2 Scrum Methodology

Scrum represents an agile methodology providing a tailored approach to managing di-
verse projects with varying requirements. Its benefits include the flexibility to select
requirements for sprints and the absence of rigid procedures to adhere to [12]. Within
the Scrum framework, key roles include the Scrum Master, responsible for removing ob-
stacles, the Product Owner, and the Scrum Team. This team is characterized by its
cross-functional composition, including developers, testers, and other specialists from rel-
evant domains, fostering the creation of adaptable and creative final products tailored to
customer satisfaction. The Scrum process is based on 3 steps:

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3.2.1 Product Backlog
The product backlog comprises requirements defined by the product owner, typically
referred to as user stories. These requirements are then segmented into sprint backlogs,
which are utilized during sprint planning to facilitate the completion of a sprint. Each
day concludes with a daily scrum meeting, focusing on the progress of tasks assigned for
that day.

3.2.2 Sprint
A sprint in Scrum is the fundamental unit of work, involving a small team focused on
specific tasks, typically lasting between 1 to 3 weeks. The tasks for a sprint are determined
by a sprint backlog, which documents all the requirements for the current sprint. The
product backlog, curated by the product owner and consisting of user stories, serves as a
repository of requirements. It is then segmented into sprint backlogs, which are used in
sprint planning to outline methods for completing the sprint. Each day concludes with
a daily scrum meeting aimed at tracking progress. The primary goal of each sprint is to
deliver a potentially shippable product [12].

3.2.3 Sprint Review

3.2.3.0.1 Following each sprint, a sprint review is conducted to present a potentially
shippable product. This entails a session with the product owner where the shippable
product increment is demonstrated, marking the culmination of each sprint[12].
Figure 3.6 illustrate the scrum process.

Figure 3.6: Scrum Process. From [7].

3.3 Requirements
In this section, we will identify all the stakeholders and potential users of the system to
specify the functional needs related to each of them and the non-functional requirements
for the system.

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3.3.1 Actors Identification
An actor is the idealization of a role played by an external person, process, or thing
that interacts with a system[79]. In our case, we identified 5 main users, namely:

• Patient: This is a person who receives or is awaiting to receive medical care within
the healthcare management system. They interact with the system primarily to
manage their appointments, access their medical records, access medical information
via the chatbot, and receive notifications and reminders.

• Doctor: This is a healthcare professional who provides medical services to patients.

They interact with the system to manage the PMR, provide telemedicine services,
and access drug interaction detection tools.

• Nurse: This is a healthcare professional responsible for the daily care of patients,
administering medications, monitoring patient conditions, and documenting care
provided. They interact with the system to update the PMR, manage care schedules,
and communicate with other healthcare professionals.

• Paramedical Professional: This is a healthcare professional responsible for the

tests and analyses conducted for patients. They interact with the system to provide
test results and analysis results in order to update the PMR.

• Pharmacist: This is a healthcare professional specialized in preparing, distributing,

and managing medications. They interact with the system to verify prescriptions
while accessing the drug interaction detection service, manage medication stocks,
and provide medication advice to patients and other healthcare professionals.

• Administrator: This is a healthcare professional who has elevated privileges within

the system. With these privileges, they can manage the healthcare facility to which
they are affiliated as well as the staff of that facility.

• Super Administrator: This is a user with the highest privileges in the system.
They are responsible for user management, system configuration, and activity mon-
itoring.

• Medical Device: This is equipment used to diagnose, monitor, or treat patients.

It interacts with the system to send patient condition data, receive treatment com-
mands, or both.

• Card Production System: This is a system that produces identification cards

for patients. It interacts with the system to receive information about new patients
in order to create their medical cards.

• Bank Service: It’s a banking system that allows online payments. It interacts
with the system by providing connection interfaces.

Figure 3.7 illustrates the context diagram of the system showing the interactions
between external actors and the system.

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 Figure 3.7: Context Diagram.

3.3.2 Functional Requirements

Our project aims to create two main platforms: a mobile one for Patients and a web one
for Healthcare Professionals, Administrators, and a company for managing administrative
procedures. The key functionalities offered to these various actors include:

• For the Patient:

– He can request the creation of an account and receive a medical card.

– He can log into their account and manage it.
– He can access and manage their medical record.
– He can search for and contact Healthcare Professionals.
– He can request and manage appointments and teleconsultations.
– He can request medical information from the system’s chatbot.
– He can access test results.
– He can manage their medication intake.

• In general for Healthcare Professionals:

– They can create an account and request account activation.

– They can log into their account and manage it.

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 – They can access and manage the PMR.
– They can search for and contact Patients and other Healthcare Professionals.

• Specifically for Doctor:

– He can provide teleconsultations and manage appointments.

– He can make AI-assisted medication prescriptions for Patients.

• Specifically for Pharmacist:

– He can manage the stock of their pharmacy.

– He can access the list of medications consumed by Patients.
– He can make AI-assisted medication prescriptions for Patients.

• Specifically for Paramedical Professional:

– He can connect their medical device to the system.

– He can send test and/or analysis results to Patients.

• For the Administrator:

– He can manage the healthcare facility to which they are affiliated.

– He can manage the staff of the healthcare facility to which they are affiliated.

• For the Super Administrator:

– He can create Patient accounts.

– He can validate Healthcare Professionals’ accounts.
– He can manage privileges.
– He can access usage statistics of the various platforms.
– He can manage the system configuration.

3.3.3 Non-functional Requirements

Non-functional requirements describe the qualities of the system. Here are the main
non-functional requirements identified for our system:

1. Performance: The system must be able to respond quickly to user requests, even
when subjected to high loads.

2. Security: The system must ensure the confidentiality and integrity of patient data
in accordance with Algerian laws on protection [80, 81]. It must also be protected
against unauthorized access and malicious attacks.

3. Reliability: The system must be reliable and available at all times, thus minimizing
downtime and service interruptions.

4. Usability: The system’s user interface must be intuitive and easy to use, to facili-
tate user adoption and reduce the need for training.

5. Compatibility: The system must be compatible with different web browsers and
operating systems, to ensure maximum accessibility for users.

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 6. Maintainability: The system must be designed in a modular and easy-to-maintain
manner, thus allowing for easy modifications and updates.

7. Scalability: The system must be scalable, capable of adapting to increasing num-

bers of users and the addition of new features in the future.

3.4 Use Case Diagrams

An UCD is an Unified Modeling Language (UML) diagram that graphically represents
the functional requirements of a system by illustrating the interactions between users
(actors) and the system itself. It describes the different ways in which users can use the
system to accomplish specific tasks [79]. In this section, we will present the different use
case diagrams related to each of the functional requirements presented above.

3.4.1 Patient’s Use Case Diagrams

The system allows the patient to request the creation of an account and receive a
medical card. Once logged in, the patient can manage their account, access and manage
their medical record, and consult test analysis results. The patient has the ability to
search for and contact healthcare professionals, request and manage appointments as well
as teleconsultations. Additionally, they can obtain medical information via the system’s
chatbot and manage their medication intake.
Figure 3.8 illustrates the interactions in the System Society for account creation and
obtaining login information and the medical card.

Figure 3.8: Patient’s UCD #1: Get account.

Figure 3.9 illustrates all interactions between the Patient and the System Mobile
App.

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 Figure 3.9: Patient’s UCD #2: All System Mobile App use cases.

Figures 3.10, 3.11, and 3.12 illustrate interactions in the System Mobile App for
managing the account and medical record.

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Figure 3.10: Patient’s UCD #3.1: Account and Medical Record Management #1.

Figure 3.11: Patient’s UCD #3.2: Account and Medical Record Management #2.

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 Figure 3.12: Patient’s UCD #3.3: Account and Medical Record Management #3.

Figure 3.13 illustrates interactions for searching and contacting a healthcare profes-
sional.

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 Figure 3.13: Patient’s UCD #4: Search and Contact Health Professionals.

Figure 3.14 illustrates interactions for managing appointments and reporting an

emergency.

Figure 3.14: Patient’s UCD #5: Appointments Management and Emergency Reporting.

3.4.2 Healthcare Professionals’ Use Case Diagrams

Healthcare professionals can create and activate their account, log in, and manage their
profile. They have access to the PMR (Patient Medical Record) which they can view and
manage, and can search for and contact patients as well as other healthcare professionals.
Doctors have the ability to provide teleconsultations, manage appointments, and

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make AI-assisted medication prescriptions for patients. Pharmacists can manage the
stock of their pharmacy, access the list of medications consumed by patients, and also
make AI-assisted medication prescriptions. Paramedical professionals can connect their
medical devices to the system and send test or analysis results to patients.
Healthcare professionals are generalized by a single actor ”Healthcare Professional”.
Figure 3.15 illustrates this generalization.

Figure 3.15: Healthcare Professionals Generalization.

Figure 3.16 illustrates all interactions between healthcare professionals and the Sys-
tem Web App.

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Figure 3.16: Healthcare Professionals’ UCD #1: All System Web App use cases for
Healthcare Professionals.

Figure 3.17 illustrates interactions between Healthcare Professionals and the System
Web App for managing their account.

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 Figure 3.17: Healthcare Professionals’ UCD #2: Account Management.

Figures 3.18 and 3.19 illustrate interactions for searching for Patients and Healthcare
Professionals, and contacting them.

Figure 3.18: Healthcare Professionals’ UCD #3: Search Patient and Contact him.

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Figure 3.19: Healthcare Professionals’ UCD #4: Collaborate with Professionals.

Figures 3.20 and 3.21 illustrate interactions for managing the PMRs.

Figure 3.20: Healthcare Professionals’ UCD #5: PMRs Management #1.

Figure 3.21: Healthcare Professionals’ UCD #6: PMRs Management #2.

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3.4.3 Administrators’ Use Case Diagrams
Administrators can manage the healthcare facility and the affiliated personnel. Super
administrators have extended responsibilities, including creating accounts for patients,
validating healthcare professionals’ accounts, managing privileges, accessing statistics of
platform usage, and configuring the system. Figure 3.22 illustrates all interactions between
the two types of Administrators and the System Web App.

Figure 3.22: Administrators’ UCD #1: All System Web App use cases for Administrators.

Figures 3.23, 3.24, and 3.25 illustrate interactions between the Super Administrator
and the System Web App for user and privilege management.

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Figure 3.23: Administrators’ UCD #2: Users Management #1.

Figure 3.24: Administrators’ UCD #3: Users Management #2.

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 Figure 3.25: Administrators’ UCD #4: Users Management #3.

Figure 3.26 illustrates interactions between the Administrator and the System Web
App for managing the healthcare facility and affiliated personnel.

Figure 3.26: Administrators’ UCD #5: Organization Management.

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Conclusion
In summary, this chapter has extensively presented the various functional and non-
functional requirements, the method of identifying these requirements, as well as the
context diagram and the use case diagrams for our system. Through these diagrams,
we have examined the various interactions among the system actors, such as patients,
healthcare professionals, administrators, super administrators, and the system itself.
These diagrams provide an overview of the system’s functionalities and interactions,
thus laying a solid foundation for the analysis and design, which will be the subject of
the next chapter, and the implementation of our system that follows.

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 Chapter 4
Analysis and Design

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Chapter 4

Analysis and Design

Introduction
Analysis and Design is a stage that follows the Requirements Specification, where the
needs and functionalities of the system have been defined. Its objective is to transform
these requirements into a detailed architecture and precise design that will serve as a
foundation for the system’s implementation. In this chapter, we will start with the devel-
opment of the conceptual model using class diagrams. Next, we will detail the dynamic
interactions of some key features through sequence diagrams. Finally, we will describe the
overall system architecture, including the database schema, main components, and their
interactions. We will also present the UX/UI design to provide a prototypes overview of
the future system. Then we will finish with the presentation of the BMC. These elements
will provide a solid foundation for the implementation phase, ensuring that the system
will be built in a consistent and efficient manner.

4.1 Class Diagram

The class diagram is considered to be the most important diagram when designing a
system, as it is the only one that is mandatory in modelling. It is used to represent the
classes that the system uses, as well as their links, whether these represent a conceptual
nesting (inheritance) or an organic relationship (aggregation). ‘A class is the formal
description of a set of objects with common semantics and characteristics’. [79]. The
figure 4.1 shows the class diagram for the system.

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 Figure 4.1: Class Diagram.

4.2 Sequence Diagram

The sequence diagram is a behavioral UML diagram representing the chronological se-
quence of operations performed by an actor. It shows the objects the actor will manipulate
and the operations that transition from one object to another [79]. The sequence diagram
of certain key and complex functionalities can be beneficial in understanding the process
of executing these functionalities. Among these functionalities, we notably include:

• The appointment request and approval functionality : This feature, from

the appointment request by the Patient to its approval by the Healthcare Profes-
sional, highlights teleconsultation services. Figures 4.2 et 4.3 illustrate the different
interactions during this process.

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Figure 4.2: Appointments Sequence Diagram #1.

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 Figure 4.3: Appointments Sequence Diagram #2.

• The medication prescription functionality for the Patient: It highlights the

ability of healthcare professionals such as Doctors and Pharmacists to prescribe
medication to the Patient. The interaction emphasizes the drug interaction check
to aid decision-making regarding the medication prescription. Figure 4.4 illustrates
the different interactions during this process.

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 Figure 4.4: Prescription Sequence Diagram.

• The system configuration functionality: It highlights the interactions involved

in configuring the system by the Administrator. Figure 4.5 illustrates the different
interactions in this process.

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 Figure 4.5: System Configuration Sequence Diagram.

4.3 System Architecture

The system architecture forms the technical foundation upon which the entire function-
ing of our system rests. At the start of our project, we opted for a classic client-server
architecture, with authentication for Healthcare Professionals and Administrators based
on our own infrastructure. However, as development progressed, we decided to migrate
to a serverless architecture, using Google Firebase for Patient authentication and auto-
matic server-side infrastructure management. This decision was driven by time constraints
and the need to simplify infrastructure management. Among the multiple advantages of
adopting this type of architecture, we can include:

• Reduction of Complexity: By delegating authentication to Firebase, we simpli-

fied our architecture and reduced the burden of infrastructure management.

• Improved Scalability: Firebase enables automatic scalability, ensuring that our

application can rapidly increase the number of users without manual intervention.

• Time Savings: Using Firebase’s integrated services allowed us to develop and

deploy more quickly, meeting our tight deadlines.

Figure ?? illustrates the final system architecture.

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 Figure 4.6: System Architecture.

4.3.1 Database Structure

The Firestore database in Firebase is a Not Only SQL (NoSQL) database based on
collections of documents. These documents are represented as JavaScript Object Notation
(JSON) objects. Code 4.1 is an example of the structure of a document in the ”patients”
collection.

1 {
2 "id": "string",
3 "healthId": "string",
4 "picture": "string",
5 "firstName": "string",
6 "lastName": "string",
7 "email": "string",
8 "phoneNumber": "string",
9 "birthDate": 0,
10 "gender": "string",
11 "town": "string",
12 "municipality": "string",
13 "street": "string",
14 "generalMedicalRecord": {
15 "medicalHistory": ["string"],

85
16 "fatherHealthId": "string",
17 "motherHealthId": "string",
18 "familyHistory": "string",
19 "bloodType": "string",
20 "metrics": [
21 {
22 "heightInCentimeter": 0.0,
23 "weightInKilogram": 0.0,
24 "systolicBloodPressure": 0.0,
25 "diastolicBloodPressure": 0.0,
26 "measureDate": 0
27 }
28 ],
29 "emergencyContacts": [
30 {
31 "names": "string",
32 "phoneNumber": "string"
33 }
34 ],
35 "allergies": ["string"],
36 "currentMedications": [
37 {
38 "professionalId": "string",
39 "drugId": "string",
40 "dosage": 0,
41 "frequency": 0,
42 "startDate": 0,
43 "endDate": 0,
44 "isFinished": true
45 }
46 ],
47 "consultationRecords": [
48 {
49 "professionalId": "string",
50 "date": "2023-06-08T00:00:00",
51 "type": "string",
52 "complaints": ["string"],
53 "physicalExamination": "string",
54 "diagnosis": "string",
55 "prescribedMedications": ["string"],
56 "testsOrdered": ["string"],
57 "recommendations": ["string"],
58 "recommendedCenter": ["string"]
59 }
60 ],
61 "labRecords": [
62 {
63 "professionalId": "string",
64 "testDate": 0,
65 "testName": "string",

86
 66 "testResult": "string"
67 }
68 ],
69 "imagingRecords": [
70 {
71 "professionalId": "string",
72 "testDate": 0,
73 "imagingName": "string",
74 "imagingType": "string",
75 "imagingResult": "string"
76 }
77 ],
78 "vaccinations": [
79 {
80 "professionalId": "string",
81 "vaccineType": "string",
82 "vaccineDose": 0,
83 "vaccineDoseNumber": 0,
84 "vaccinationDate": 0,
85 "administrationSite": "string",
86 "batch": "string",
87 "serialNumber": "string",
88 "sideEffect": ["string"],
89 "status": true
90 }
91 ],
92 "vitality": true
93 },
94 "healthCard": {
95 "creationDate": 0,
96 "qrCodeData": "string",
97 "pinCode": "string",
98 "password": "string"
99 }
100 }
Listing 4.1: Firestore Json Structure for Patient Document

4.4 UX/UI Design

The User Experience (UX) design defines the experience a user would go through when
interacting with a company, its services, and its products, while User Interface (UI) design
defines the visual components that the user can see and interact with [82]. These designs
allow for the system to be conceived from the perspective of the end users. When well
incorporated into a software project, among many advantages, they increase user retention
by offering a good user experience and efficient use of the software in question. In this
section, we will present the conception of these two design notions as well as the techniques
used to improve UX and make the UI user-friendly.

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4.4.1 User Experience
The adoption of certain features and techniques significantly improves UX. Among
many, we can mention:

• Dark Mode: Switching the application theme to a dark theme is an emerging trend
in UX design, both ergonomically and aesthetically [83]. It significantly reduces eye
strain, decreases glare, and improves energy efficiency when combined with Organic
light-emitting diode (OLED) technology.

• Consistent Visual Design: Consistency between different interfaces allows the

user to navigate smoothly between them. This includes integrating descriptive icons,
a coherent design scheme, and a clear visual hierarchy.

• Web Content Accessibility Guidelines (WCAG): A set of guidelines devel-

oped by World Wide Web Consortium (W3C) to make web content more accessible
to people with disabilities. These guidelines include alternative texts, keyboard
navigation, etc.

4.4.2 User Interface

Thanks to our extensive experience in handling a large number of web and mobile
software, and being users of these software ourselves, we were able to identify the features
of the software that appealed to us in terms of modern design, simplicity and minimalism,
visual consistency, and choice of color palette. The UI design combines with UX design
to enhance the visual and interactive experience of the end user. Figures 4.7 and ??
illustrate some wireframes before the choice of the color palette and logos.

Figure 4.7: Mobile App Wireframe.

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Figure 4.8: Web App welcome and login Wireframe.

Figure 4.9: Web App Dashboard Wireframe

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 Figure 4.10: Web App for Hover interface

4.4.2.1 Color Palette

The choice of color is crucial for good visual perception by the end users. We chose
shades of blue and green because in the medical field, these colors are used more than
others, mainly due to their psychological effect. In addition to white, figure 4.11 illustrates
the two main colors used in the platforms.

Figure 4.11: Color Palette.

The figures 4.12 and 4.13 illustrate the application of these colors on the wireframes
seen above as well as the resulting prototyped design.

90
Figure 4.12: Mobile Prototypes.

Figure 4.13: Web Prototypes.

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4.4.2.2 Logo Design
The ”Hyati Medical” Company logo embodies our spirit of innovation and forward-
thinking vision that sets us apart in the healthcare sector. Designed with vibrant colors
and sleek, modern lines, it symbolizes the dynamism and ambition we are known for.
Shape: The stethoscope, a universal symbol of health, is central to the logo’s design.
Its form draws the viewer’s attention, while the inner part of the stethoscope represents
happiness. Additionally, the stethoscope and a letter together form the number twenty-
four, symbolizing our commitment to round-the-clock availability and creating a positive
impact.
Text: We chose ”Hyati Medical” for the text, inspired by the diary of an Algerian
citizen who regards health as his most valuable asset. This name resonates with our
mission to be close and relatable to our users.
This logo encapsulates our identity and core values. It reflects our dedication to
innovation and continuous improvement, aiming to deliver high-quality healthcare services
to our customers

Figure 4.14: Logo.

4.4.2.3 Dicha Chatbot

It’s the medical chatbot that interacts with users to provide them with medical infor-
mation. Its name comes from meDical chatbot.

4.5 BMC
The BMC is a strategic tool used to develop and document business models. It was
designed by Alexander Osterwalder and Yves Pigneur and is presented in the form of a
visual canvas comprising nine blocks. Each block represents a key aspect of a business,
thereby allowing for the visualization and analysis of the entire business model in a co-
herent and integrated manner [84]. In our context, these nine blocks provide an overview
of our business model. These blocks include:

4.5.1 Key Partners

The Key Partners block describes the network of partners and suppliers necessary to
carry out key activities and access key resources. These include:

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 • Health Professionals: Collaborating with doctors, nurses, and other medical pro-
fessionals to ensure that the platform meets clinical needs and enhances patient
care.

• Medical Institutions: Encompassing hospitals, clinics, pharmacies, laboratories,

etc.

• Cloud Service Providers: Such as CERIST ”Centre de Recherche sur l’Information

Scientifique et Technique,” providing web hosting and domain name services in .dz.

• Computer Equipment Suppliers: Working with computer equipment suppliers

to ensure compatibility and support for necessary hardware, such as servers and
networking devices.

• Medical Insurance Providers: Partnering with medical insurance companies

like CNAS and CASNOS to facilitate integration with insurance systems for claims
processing and patient coverage verification.

4.5.2 Key Activities

This block presents the key activities necessary to deliver value propositions, reach mar-
kets, maintain customer relationships, and generate revenue. This includes production,
marketing, customer relationship management, etc. These activities are:

• System Development and Maintenance: Developing and maintaining web and

mobile platforms.

• Data Management: Integrating and managing data from various healthcare sys-
tems for comprehensive patient records.

• Customer Support:

– Technical Support: Providing 24/7 support to healthcare providers and pa-

tients.
– Training: Offering training sessions and materials for effective platform use.

4.5.3 Key Resources

This block presents the key resources necessary to deliver value propositions, reach
markets, maintain customer relationships, and generate revenue. These resources can be
physical, intellectual, human, or financial. They include:

• Human Resources: Developers, IT support technicians, Healthcare Specialists

(doctors, pharmacists).

• Technology Resources: Servers and Static IP Addresses for Launching Services

and Storing Patient Data.

• Physical Resources:

– Production Facilities: Space and equipment for making health cards.

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4.5.4 Value Propositions
This block describes the products and services that create value for the customer seg-
ment. They include:

• Streamline Medical Records Management: Improve the efficiency of managing

medical records.

• Incorporate AI: Use AI to assist patients by providing a patient chatbot and an

AI-powered drug interaction checker for healthcare professionals.

• Empower Patients: Engage patients as active participants in the system and

foster collaboration between patients and healthcare providers.

• Create Collaborative Spaces: Establish collaborative environments for health-

care professionals to enhance teamwork in delivering patient care.

• Connect Medical Devices: Integrate medical devices with the platform to facil-
itate seamless sharing of medical information.

4.5.5 Customer Relationships

This block presents the types of relationships the company establishes with its customer
segments. These may include personalized support, online communities, self-service, etc.
They include:

• Client Support

• Self-service Options: Create a user-friendly mobile app for patients to access,

view, download, and share their medical records, empowering them in their health-
care journey.

• Automated Assistance in Platforms: Provide automated assistance tools for

healthcare providers.

4.5.6 Channels
This block describes how the company reaches and communicates with its customer
segments to deliver its value propositions. This includes communication, distribution,
and sales channels. They include:

• Direct Sales: Selling application licenses and offering a trial period for healthcare
professionals.

• Medical Conferences and Events

• Healthcare Salons and Networking Events

• Online Webinars and Workshops

• Web Platform

• Mobile Platform

• Social Media

94
4.5.7 Customers Segments
This block describes the targeted customers of the company. It identifies the different
groups of people or organizations that the company seeks to reach and serve. They
include:

• Patients with Chronic Health Conditions: Including individuals diagnosed

with diabetes, high blood pressure, or other long-term diseases, as well as patients
needing urgent care and pre-surgical patients.

• Health Professionals:

– Doctors, nurses, pharmacists, and others who manage patients with chronic
diseases face problems such as:
∗ Collecting and reviewing patient medical history
∗ Administrative burdens when managing medical records
∗ Lack of cooperation among themselves and collaboration with patients

4.5.8 Cost Structure

This block presents the costs incurred by the business model. It identifies the ma-
jor costs associated with operating the business, including costs of key resources, key
activities, and key partnerships. They include:

• Fundamental Expenses: These encompass the acquisition of essential equipment

vital for our organization, ranging from office supplies to computers. Additionally,
there are expenses associated with leasing a central server headquarters. The total
cost required to procure all necessary equipment and essentials for launching the
project is estimated at 6,903,400 DA.

• Fixed Costs: Our project incurs fixed expenses such as telephone and internet
subscriptions, along with other necessary supplies crucial for project continuity,
estimated at 351,825 DA.

• Personnel Expenses: Staffing costs include salaries for developers and DevOps
developers, commencing at 40,000 DA per month. With a requirement for three such
professionals, the total monthly staff expenditure amounts to 120,000 DA, totaling
an annual estimate of 1,440,000 DA.

4.5.9 Revenue Streams

This section presents how the company generates revenue. It details revenue sources
stemming from customer segments, such as product sales, subscriptions, licenses, etc.
These sources include:

• License Sales: Licenses for medical centers and physicians range from 300,000
DA to 800,000 DA per license, depending on the application’s functionality. By
selling 10 licenses, the total revenue will amount to 3,000,000 DA. Additionally, we
provide a drug interaction tool to assist healthcare professionals. Initially free, this
tool costs 4,000 DA per physician after 1,000 prescriptions. For 100 physicians, this
amounts to 400,000 DA.

95
 • Health Card Production: For each health card produced for patients, we charge
1,000 DA. If we produce 1,000 cards, the total revenue will be 1,000,000 DA.

• Teleconsultation Service: Teleconsultations are billed at 60% of the cost of in-

person consultations. We take a 15% commission on each teleconsultation. For
example, if an in-person consultation costs 2,000 DA, a teleconsultation costs 1,200
DA and our commission is 180 DA per teleconsultation. Assuming 1,000 teleconsul-
tations per day, the daily revenue would be 180,000 DA, and the monthly revenue
would be 5,400,000 DA.

Figure ?? illustrates the Business Model Canvas (BMC).

Figure 4.15: BMC.

Conclusion
In summary, this section presented the design of the system, both architecturally and
visually. We outlined the type of architecture chosen, providing justifications for our
choice, and described the resulting architecture. Additionally, we conducted a UX/UI
design of the system to represent it from the end users’ perspective and the presentation
of the business model. This significantly strengthens the foundations and prerequisites for
the implementation of the future system, which is the subject of the next chapter titled
”Realization”.

96
Chapter 5
Realization

97
Chapter 5

Realization

Introduction
This chapter details the practical implementation of the system design discussed in the
previous chapters. It covers the technical and technological choices made, the development
process, and the integration of various components. We will also present the fine-tuning
techniques of the chosen AI model as well as the main interfaces and functionalities
developed, highlighting the steps taken to ensure a seamless and efficient user experience.
By the end of this chapter, readers will have a comprehensive understanding of how the
theoretical design was translated into a functional and operational system.

5.1 Technical and Technological Choices

In this section we will see the technologies used to ensure collaboration as well as the
tools and development environments.

5.1.1 Collaboration and Design Technologies

These technologies have allowed us to collaborate effectively remotely while being su-
pervised by our supervisor. They are among others :

5.1.1.1 Google Meet

A videoconferencing service developed by Google. It allows in particular to launch

meetings or to join which was useful for us to debrief on the progress of the project.

98
5.1.1.2 Git/GitHub

It is a project version management platform allowing to follow its evolution and to

know all the deployed versions. Its advantages are the collaboration on the same project
of several collaborators and the management of changes as well as its integration into
several development environments.

5.1.1.3 Overleaf
It is an online Latex editor that allows real-time collaboration. Despite its complexity
due to the Latex language, it is powerful in terms of layout management once mastered. It
also offers the possibility to preview the resulting PDF document. We used the free access,
which limits the compilation time for large projects, to write our thesis in collaboration.

Figure 5.1: Overleaf Environment.

Figma
It is a collaborative web application for interface design, with additional offline features
enabled by desktop applications for macOs and Windows. The feature set of Figma focuses
on user interface and user experience design, with an emphasis on real-time collaboration
[85], utilizing a variety of vector graphics editors and prototyping tools.

99
 Figure 5.2: Figma Environment.

Draw.io
Draw.io is a robust technology stack designed for constructing diagramming applica-
tions. A key strength of draw.io lies in its comprehensive support for UML (Unified Mod-
eling Language), a standardized method for visually representing software systems[86]. It
offers the following features:
• Effortless UML Diagramming: With a drag-and-drop interface and pre-made
UML shapes, draw.io enables quick and easy diagram creation.
• Versatile UML Support: Draw.io supports a variety of UML diagrams, including
class diagrams and use case diagrams, among others.
• Real-Time Collaboration: An added advantage of draw.io is its real-time collab-
oration feature, allowing multiple users to work on the same UML diagram simul-
taneously.

5.1.2 Mobile development tools

Those are tools used specifically to implement the system at the mobile level. They are
among others:

5.1.2.1 Android Studio

100
 According to Wikipedia, ”Android Studio is the official Integrated Development Envi-
ronment (IDE) for Google’s Android operating system, built on JetBrains’ IntelliJ IDEA
software and designed specifically for Android development”. We chose it to allow the
development of the mobile application under Android. It uses languages like

• Kotlin or Java for the backend;

• Extensible Markup Language (XML) or Kotlin for the front-end.

Figure 5.3: Android Studio Environment.

5.1.3 Web development technologies

These are the tools that allowed us to implement the web part of the system.

5.1.3.1 Front-end
Front-end development, also known as client-side development, is the practice of pro-
ducing HTML, CSS, and JavaScript for a website or web application so that a user can
see and interact with it directly we utilize the following frameworks:

5.1.3.2 Font Awesome

It is a font and icon toolkit based on CSS and Less. As of 2023, Font Awesome was
used by 30% of sites that use third-party font scripts, placing Font Awesome in second
place after Google Fonts[87]

Tailwind CSS Tailwind CSS is an open-source CSS framework. The main feature of
this library is that, unlike other CSS frameworks like Bootstrap, it does not provide a
series of predefined classes for elements such as buttons or tables. Instead, it creates a list
of ”utility” CSS classes that can be used to style each element by mixing and matching[88]

101
BootStrap Is a free and open-source CSS framework directed at responsive, mobile-
first front-end web development. It contains HTML, CSS, and (optionally) JavaScript-
based design templates for typography, forms, buttons, navigation, and other interface
components [89].

Alpine.js It is a minimal JavaScript framework for adding JavaScript behavior to

markups. It’s designed to be lightweight and easy to use, with a syntax similar to Vue.js.
Alpine.js allows you to have rich, interactive front-ends without the need for a build step
or a full-blown JavaScript framework [90]

5.1.3.3 Back-End
Back-end development refers to server-side development, where the core computational
logic resides. This universal concept applies to both web and mobile applications. It
includes creating and maintaining the database, scripting, designing the application ar-
chitecture, and implementing algorithms to ensure proper functionality[91]. The back end
interacts indirectly with the front end to provide information and functionality[92], rather
than directly contacting the user. We utilize the following languages and frameworks to
complete the connection:

Laravel Laravel is a free and open-source PHP-based web framework for building high-
end web applications [93]. It was created by Taylor Otwell and intended for the de-
velopment of web applications following the model–view–controller (Model View Con-
troller (MVC)) architectural pattern and based on Symfony. Some of the features of
Laravel include a model packaging system with a dedicated dependency manager, differ-
ent ways for accessing relational databases, utilities that aid in application deployment
and maintenance, and its orientation toward syntactic sugar [93].

5.1.3.4 Visual Studio Code

Visual Studio Code is an open-source code editor developed by Supporting a huge num-
ber of languages thanks to extensions. He supports auto-completion, syntax highlighting,
debugging, and git commands[94].

5.2 BioBERT Fine-tuning

As we have seen in the chapter ”Literature Review”, BioBERT is initially trained on
a large medical corpus. To make it even more effective in specific tasks such as NER,
RE, or QA, it needs to be fine-tuned as per the article [6]. The pre-trained model is
available at https://github.com/dmis-lab/biobert,we conducted a fine-tuning pro-
cess. Fine-tuning involves taking the pre-trained BioBERT model and training it further
on task-specific datasets. This step is crucial for enhancing the model’s performance in
our targeted applications: Following the guidelines from the original BioBERT paper by
Lee et al. (2019), we utilized this model as a base for our fine-tuning process

• NER (Named Entity Recognition): We fine-tuned BioBERT using annotated

biomedical texts to accurately identify and classify entities such as diseases, medi-
cations, and anatomical terms.

• RE (Relation Extraction): For extracting relationships between entities, BioBERT

was fine-tuned on datasets that describe interactions between medical terms.

102
 • QA (Question Answering): We further trained BioBERT to answer domain-
specific questions by providing it with a comprehensive set of biomedical questions
and answers.

5.2.1 Dataset:
The pre-trained model is available at https://github.com/dmis-lab/biobert and it
provides a pre-processed version of benchmark datasets for each task as follows:

• Named Entity Recognition: (17.3 MB), 8 datasets on biomedical named entity

recognition.

• Relation Extraction: (2.5 MB), 2 datasets on biomedical relation extraction.

• Question Answering: (5.23 MB), 3 datasets on biomedical question answering

task.

5.2.2 Implementation Steps

The first step in the implementation is to follow the repository steps that exist in the
GitHub link https://github.com/dmis-lab/biobert to run the BioBERT model and
evaluate it to match our business needs for detecting drug interactions and Question
Answering, This is steps to starting run mode by

Data Preparation:
We collected and prepared task-specific datasets for NER, RE, and QA. This involved
annotating text, structuring data, and splitting it into training and validation sets from
repository

Model Training:
Using the pre-trained BioBERT model, we performed fine-tuning on our prepared datasets
by running Named Entity Recognition (NER). The token-level evaluation result for the
NCBI disease corpus will be like:

processed 24497 tokens with 960 phrases; found: 983 phrases; correct: 852.
accuracy: 98.49%; precision: 86.67%; recall: 88.75%; FB1: 87.70
MISC: precision: 86.67%; recall: 88.75%; FB1: 87.70 983

Validation Data
After training a pre-trained BioBERT model with Named Entity Recognition (NER)
datasets, you got a result ”BERT-BASE”.

103
 Table 5.1: Performance of the fine-tuned BioBERT model on the NER task

Entity Type Precision Recall F1-Score Support

PER 0.9677 0.9756 0.9716 1842
LOC 0.9671 0.9592 0.9631 1837
MISC 0.8872 0.9132 0.9001 922
ORG 0.9191 0.9314 0.9252 1341
Avg/Total 0.9440 0.9509 0.9474 5942

Additional Data
Here are additional results obtained from the model.

Table 5.2: Additional performance of the fine-tuned BioBERT model on the NER task

Entity Type Precision Recall F1-Score Support

ORG 0.8773 0.9037 0.8903 1661
PER 0.9646 0.9592 0.9619 1617
MISC 0.7691 0.8305 0.7986 702
LOC 0.9333 0.9305 0.9319 1668
Avg/Total 0.9053 0.9184 0.9117 5648

Model Evaluation:
After fine-tuning, we evaluated the model’s performance in the validation dataset to ensure
that it met the performance benchmarks for each task. This included measuring metrics
such as NER, RE, QA task accuracy, recall, and F1 scores.

Model Deployment:
Once the model demonstrated satisfactory performance, we deployed it within our appli-
cation framework. This step included integrating the model into our existing system and
ensuring it could effective.

By fine-tuning BioBERT for our specific tasks, we have been able to significantly en-
hance its ability to identify and process biomedical information. This improved model
now delivers outputs that are both more reliable and accurate, meeting the critical needs
of our application.

5.3 Interfaces Presentation

In this section, we will cover the main interfaces of the system for the web and mobile
application.

5.3.1 Web application Interfaces

Figure 5.4 represents the welcome page for healthcare professionals and the admin inter-
faces.

104
 Figure 5.4: Web App Interface #1 : Welcome Page

Figure 5.5 represents login page interface.

Figure 5.5: Web App Interface #2 : Login Page

Figure 5.6 represents the admin and super admin dashboard interface.

Figure 5.6: Web App Interface #3 : Administrators’ Dashboard

105
Figure 5.7 represents the permissions and roles configuration in the platform.

Figure 5.7: Web App Interface #4 : Permissions and Roles Configuration.

Figure 5.8 represents the permissions and roles synchronisation.

Figure 5.8: Web App Interface #5 : Permissions and Roles Synchronisation.

Figure 5.9 represents the healthcare management interface.

106
 Figure 5.9: Web App Interface #6 : Healthcare Management.

Figure 5.10 represents the patient management interface.

Figure 5.10: Web App Interface #7 : Patient Management

Figure 5.11 illustrates the Patient’s Health Card Information.

Figure 5.11: Web App Interface #8 : Patient’s Health Card Information.

107
5.3.2 Mobile App Interfaces
The figure ?? illustrates the main welcome screen when the application is launched for
the first time.

Figure 5.12: Mobile App Interface #1 : Welcome Page.

The figures 5.13 and 5.14 illustrate the login page in the mobile application where
patients can log in using their login credentials or scan their medical card and provide the
pin code

108
Figure 5.13: Mobile App Interface #2 : Connexion Page #1.

109
 Figure 5.14: Mobile App Interface #3 : Connexion Page #2.

The figure 5.15 illustrates the patient’s home screen. On this interface, they have
the ability to navigate between the different interfaces: home, discussions, search, noti-
fications, and settings. On the home screen, they can access and manage their account
information, access and manage their medical record, manage appointments, manage
taken medications, and view test and analysis results. They can also overview their med-
ical ID and QR code (for search by healthcare professionals in case of forgetting or losing
the card) and report a medical emergency for themselves or another person

110
 Figure 5.15: Mobile App Interface #4 : Home page.

The figure 5.16 illustrates the discussion interface where the patient can see the list
of their discussions, start a new discussion with professionals, or ask for information from
the Dicha chatbot

111
 Figure 5.16: Mobile App Interface #5 : Discussion page.

Conclusion
In summary, in this chapter we have seen the different techniques and technologies
used during the development of the project as well as the results obtained following the
practical application of the theoretical frameworks discussed in the previous chapters.
These results have been defined by two web and mobile platforms respectively for Health
Professionals and Administrators, and Patients. We have seen the main interfaces from
these platforms which give an overview of the final system.

112
Chapter 6
Conclusion

113
Chapter 6

General Conclusion

In conclusion, this thesis has addressed the need to advance the digitization of health-
care services in Algeria through the development of an innovative platform integrated into
the Algerian NHIS. We have defined the objectives of this project, which are to address
the challenges encountered in the digitization process, namely communication barriers,
decentralization of healthcare services, patient empowerment, medical data management,
care coordination, and integration of cutting-edge technologies such as AI.
To achieve these objectives, we first defined key concepts related to e-health and
its impact on healthcare services and patients. Then, we conducted a state-of-the-art
review to understand current advancements in this study context. This allowed us to
identify the current needs of various stakeholders in relation to our objectives and to
design these needs into a final system consisting of two mobile platforms for Patients and
a web platform for Healthcare Professionals. The adoption of the Scrum methodology
provided a flexible and efficient framework for project development, enabling effective
communication, problem-solving, and alignment with organizational objectives.
In summary, this thesis represents a significant step towards addressing the chal-
lenges encountered in the digitization of healthcare services in Algeria. By developing an
integrated platform that enhances patient engagement, facilitates communication among
stakeholders, and leverages advanced technologies, we aim to contribute to the advance-
ment of healthcare delivery and improve the quality of care for the Algerian population.
Although the journey has been marked by various challenges and obstacles, the ideas and
solutions proposed pave the way for future research, innovation, and continuous improve-
ment in the field of digital health.

Perspectives
In order to improve this project, we thought about integrating certain features during
its development, such as:

• Geolocation for emergency declaration services aimed at directing Patients to the

nearest hospital center and optimized search for health professionals.

• The development of a connected device of the watch type to provide real-time

information on the patient’s condition.

• Online medication purchase with integration of health insurance services such

as CNAS and CASNOS.

114
Appendix A

Internship Reports

115
Figure A.1: Mohamed Diop’s Internship report.

116
 Repubtique Atgerienne D6mocratique et poputaire
Ministdre de l'Enseignement Sup6rieur
Et de ta Recherche Scientifique
Universitd lbn Khaldoun - Tiaret
Facultd des mathdmatiques de I'informatique
D6partement lnformatiq ue

rIICHE P' APPRECIATION DU S TAGIAIRE

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117
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Figure A.3: Kheir Eddine Chebicheb’s Internship report #2.

118
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