Friday, March 21, 2008

Electronic Schedules

To control health care wait times you need first need to be able to tightly control the schedule. To control the schedule you need to have visual cues. Visual cues are differences in the schedulers appearance based on the type of appointment booked. You're brain cannot process the complexity of a schedule with just a list of names. It processes information much more effectively when it can visualize the blocks of time, appointment types and work to be completed symbolically. In fact, it would process the information best if the schedule were in 3-dimensions and had auditory cues as well!

How do you add depth & visual cues to a scheduler and what makes a good scheduler?

First, if you still have a paper schedule it’s bad. Paper schedules make it nearly impossible to search for patients going forward, block book or retrospectively examine how schedules are being managed. They're completing lacking in richness and visual cues. In addition, when there is more than 1 provider they become hopelessly inefficient.

Now that I’ve got that rant out of the way, what makes a good electronic scheduler? Think back to the blog on the 5S’s of organization: Sorting, Simplifying, Sweeping, Standardizing and Sustaining and apply it to electronic schedules. In terms of an electronic scheduler that means that it should:

Sorting: Show all necessary but no extraneous information on the screen. Unless you need a bit of information on a daily basis it should not be shown, and if you do need it daily it should be. Having email type messages showing is a good example of what distracts the brain and should not be there. Two main items should be present: First each patient name has their contact number in the block and small cues for overdue accounts, pending lab results, etc… In our EMR there are small text messages beside the name for account information, pending lab work, etc... Second and most importantly the schedule is you’re administrator’s digital dashboard to organize the practice. Menus for 95% of the actions (clicking) that need to be competed for clients should be accessible with a right-click on the appointment.

Simplifying: There should be an order to the way patients are shown in the schedule. In our practice we have a ‘priority’ column (for consultations and procedures) and an ‘other’ column for post-op/quick checks. Each appointment type has a colour code to make it easily identified. The menus that allow most patient actions to be completed simplifying the ‘hunting’ that can occur with menus that are at the top of the screen. For instance menus to bill a patient or book another appointment and enter treatment should all be accessible from this main screen.

Sweeping: At the end of each day any incomplete work should be easily identified. In our system the left margin of each appointment has a coloured bar to indicate patient status. The day end cannot be run until each patient has been accounted for. This prevents incomplete work being overlooked.

Standardizing: On the schedule the way that appointments are booked should be standardized (see block booking examples). The background colours of the schedule should indicated which patient groups should be booked into those time slots. This allows visual controls on the block booking decisions that have been made with respect to ideal wait times. In our system we create different templates (all surgery day, hospital day, mix consult/surgery day, etc…) then load them to each day for each doctor. At first it’s laborious but with practice is built quickly and controls the schedule well.

Sustaining: The schedule should allow you to change visual cues on the fly. Appointment type names, colours, block booking backgrounds (and types of block booking templates). The view should be modifiable to change the number of days, provider or offices shown (ours also shrinks to view more days at a time for quick scans to find open appointment slots).

Here's a quick summary of the features I think are important:
Coloured backgrounds for different time slots to for block booking
Priority and Other column for each provider
Adjustable view for number of appointment and days to be shown
Individual Appointments:
Different colours for different types of appointments
All menus are accessible with a right-click on the appointment
Critical information (Name, Contract Number and reason for appointment) on schedule
Symbols for pending work
Symbols for status of appointment (in ours we use a coloured bar on the left) booked, confirmed, arrived, finished
What shouldn't be on the schedule:
Anything that is not used daily: client address, email messages, etc..

Medical alerts are nice to have on the schedule but my experience has been that the field is often used for non-critical information ("Give pt lab req at next appt"). It tends to clutter the screen and for more personal medical alerts can cause privacy concerns.

The electronic schedule may be the single most important tool in your arsenal to decrease surgical and health care wait times. If you are not familiar with different types, ask you’re administrative staff if they like the current system and if they’ve seen any that are better. when choosing an EMR the work flow to the scheduling screens needs to be a major factor in choosing a vendor. Below is a screen shot of what we use which is provided by Optimicro Technologies. I do not have any financial interest with this company other than using their product.

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