Ponder this for a moment: How enticing (let alone efficient) would it be to have a single computer system in your healthcare organization to track and trace persons (patients, staff and visitors), processes (practices and workflow) and products interoperably? Think of it as HAL without the spurious attitude from “2001: A Space Odyssey” or the MacGuffin-like Starfleet computer on the U.S. Enterprise in “Star Trek.”
Short of a hospital-wide enterprise-resource planning (ERP) system, industry experts acknowledge that we’re not there yet but perhaps enroute. Healthcare organizations, by and large, allow their departments to invest in their own software and systems with the Information Technology (IT) department assisting in some ways to get them all to interact.
On the surface, healthcare-oriented scheduling systems may conjure up images of an electronic clipboard for patients to get on a list to visit a doctor or to reserve an operating room for an elective surgical procedure or for clinicians to determine on the fly where to send a patient who needs emergency surgery – stat!
But effective and efficient scheduling systems encompass so much more than that. They may record and track where a patient, staffer (clinician and administrator) or visitor goes but they also can do the same thing for product consumption and use or even how frequently hands are washed.
After all, if Supply Chain sources, tracks and traces what’s brought in, then the clinical departments, such as laboratory, radiology and surgical services, for example, should track and trace what’s done to patient and the products used for and on them.
Ideally, scheduling systems should be easy-to-learn and user-friendly, intuitive to a degree, enable customization and mobility, comply with regulations and rules, generate accurate and reliable records and reports, come with helpful customer support and be cost effective. In a spirited interview with Healthcare Purchasing News Senior Editor Rick Dana Barlow, six scheduling system experts share their thoughts on integrating administrative, clinical, financial and operational multifunctionality within healthcare systems on the way toward authentic interoperability.
HPN. What are some of the key factors that should be considered when sourcing, evaluating and choosing scheduling systems for the OR and why?
1. Ease of implementation is pretty critical. Hospitals have a number of competing priorities, many of them involve IT support. Scheduling systems that require significant IT resources during the implementation process delay the hospital’s ability to begin recognizing the value the scheduling system can create.
2. Ease of use is also important. The Scheduling System should be easy to access and easy to utilize by all users…from the OR to the SPD to Supply Chain to suppliers and more.
3. Adaptability is also important. Looking at a scheduling system which cannot interface with the hospital’s legacy systems just creates one other system that has limited reach…and impact. The system should be able to communicate with all needed users from the OR, SPD, Suppliers and Supply Chain.
4. The system should be able to demonstrate measurable impact, otherwise, it is just a calendar. Metrics such as on-time deliveries, on-time case starts, volume/# of trays, contract compliance, etc. are critically important to the success of the system. Scheduling systems do a great job in creating efficiencies. However, the scheduling systems that are most unique and create the most value are the ones that not only drive efficiencies, but also have the ability to generate measurable hard dollar savings.
5. The robustness of the system is also important. How far ahead can the SPD professionals assess inventory status for an upcoming case? Do the vendors have access to see their upcoming cases? Can the system handle all kinds of inventory (e.g., owned, consigned and loaners), etc.
6. And of course, price and value are critically important. When looking at value, consider the hospital should take some time to identify exactly what they hope to gain from the scheduling system. If the scheduling system of choice merely an electronic calendar that provides greater visibility/transparency, it will do very little in creating measurable value. From a pricing point of view, hospital should understand exactly how the scheduling system supplier is priced. Some scheduling systems reduce the charge to the hospital and will in turn, charge vendors to utilize their system. Others price relative to surgical case volume. The point is pricing such as that rarely creates a win-win for the hospital. Best to work with scheduling system suppliers who have very clear, easy-to-understand pricing, along with the benefits and dollar savings they will generate.
Niloy Sanyal, Chief Marketing Officer, LeanTaaS: Look for tools and capabilities that drive prescriptive action and not those that just admire the problem.
- Real ROI from past system-wide implementations. LeanTaaS has executed OR scheduling optimization across 43 health systems and 2,400 ORs with a history of strong ROI execution. LeanTaaS differentiation also stems from a unique commercial offer of zero financial risk to our customers.
- A surgeon-centric solution is key to success.
- Measure the right metric to make sure you are making the right impact. Example, collectible time is a better metric than block utilization.
- Know that your EHR is not designed for predictive decision support.
- Your in-house IT team will not be able to create an AI-powered, end-to-end digital solution that has been tested and scaled across 100+ health systems.
Unfortunately, there is no one perfect scheduling system on the market right now that also has all of the additional interfacing programs needed: EHR, billing, scheduling, materials. There are suppliers that can provide all the IT systems needed, but few healthcare systems can afford to convert all IT systems at the same time, both financially and resources required for such a conversion.
So it is very important to define your organization’s needs, both short term and long term. Your organization may need a scheduling system that is usable across multiple locations, such as the [ambulatory surgery center] (ASC) and acute care operating rooms settings. But even if the organization doesn’t have an ASC today, there may be plans for one in the future, and organizations would want to be able to use their existing scheduling system once the ASC is built.
When it comes to evaluating scheduling systems, what’s the leading factor on the minds of the OR that should be kept in mind when sourcing prospects and why?
RECHIN: The OR is highly interested in driving surgeon satisfaction, so a leading factor should be on-time case starts and ensuring the surgeon’s requested inventory is where it is supposed to be, on-time and ready-to-go. Another issue should be to consider the scheduling system supplier’s install base.
SANYAL: Real ROI from system-wide implementations. LeanTaaS’ iQueue for Operating Rooms solution has consistently delivered $500K per OR per year across 43 health systems and over 2400 ORs. This is a result of 7% improvement in Staffed room utilization, 6% increase in case volumes and 5% increase in block utilization.
What else is important?
- A system that increases the reliability of accurate scheduling
- Electronic scheduling to eliminate paper processes that are prone to additional errors
- Having a system that not only provides reports, but enables users to look deeper into the data beyond the reports to identify the issues behind the data report
- Seamless connectivity with other systems: billing system, charge data master, EHR, and materials management supply chain item master. This will allow for accurate clinical, supply and charge documentation, as well as ensure the right products will be at the right place at the right time
- Networking between all systems will also provide improved tracking of supply and implant utilization, cost-per-case actual and projections, revenue projections and provide improved budgetary planning.
Technology is only as good as the policies and procedures put in place for the system, so organizations will need to ensure the strength of those policies and procedures. In addition, they should consider how much support and intelligence they are going to receive from the scheduling system company.
Finally, with the staffing shortage, organizations need to look at staff retention and satisfaction. Redundancy in work is a major frustration for staff, so the system needs to be useful for them as well. Leadership oftentimes makes these types of decisions, but staff need to be involved in the review of system and have input into the final decision-making.
How much sense does it make to invest in a surgical scheduling system with built-in capabilities to interface/integrate with the billing system and charge data master, EHR/EMR system and supply chain’s item master as well as mobile devices – all securely – and why?
RECHIN: The one reality everyone can count on with the OR schedule is that it changes. If the system cannot interface with the EHR/EMR system, it is virtually impossible to provide communication on scheduled case changes or updates. Some systems, such as ReadySet Surgical, works with/interfaces with the hospital scheduling system to ensure that all updates and communications occur in real-time.
Hospitals should consider scheduling systems that can create end-to-end value; meaning from the moment the case is scheduled, until the moment the case is completed, billed and the loaned inventory has been picked up from the hospital. To invest in a scheduling system that can only provide daily updates on planned inventory misses the point.
It is not only important to interface with the hospital’s EHR/EMR system, but also the hospital’s ERP. This provides a complete and seamless flow of information without the need for human intervention on the hospital side. ReadySet Surgical (RSS), as an example, provides a comprehensive management system which interfaces with the hospital’s ERP, the EHR/EMR system and supply chain’s item master, so they not only can provide real-time alerts on schedule changes, but they also can track vendor delivery performance, alert supply chain and OR leadership to any planned/requested off-contract inventory requests, verify the submitted charge sheet’s pricing is accurate, and if it is not, update it to the contracted rate, etc.
Accessibility is critically important to the success of the scheduling system. ReadySet Surgical’s system is easily accessible thru any hand-held device, the ReadySet Surgical app, or via the web/the user’s laptop. Scheduling systems need to be able to provide benefit for all users, not just the hospital, so a system that cannot allow a vendor rep to check in inventory without being on-site, creates a lot of inefficiency. ReadySet’s system allows a rep to check in their onsite inventory with the touch of a button, on their mobile device, saving valuable time and money.
SANYAL: It makes no sense to invest in a ‘surgical scheduling system’ above and beyond the EHR. But it makes all the sense in the world to invest in a ‘surgery schedule optimization system.’ It is important to make a clear distinction between scheduling and optimization. Scheduling is the act of putting down a specific appointment onto a calendar, regardless of whether the calendar is on paper, on a spreadsheet, or on an online calendar of some sort. Optimization is the underlying intelligence that determines the best option for scheduling a particular type of appointment or allocating a specific type of asset based on the sophisticated consideration of dozens of factors that influence both the supply side as well as the demand side of that decision.
Technology that embeds optimization into online scheduling tools is ubiquitous in today’s sophisticated business environment, where profitability depends upon executing a high volume of transactions while maintaining a high level of asset utilization.
A good analog would be if you open an account on Charles Schwab. Sure, you can trade stock and bonds, but you don’t get any real guidance on how best to allocate your portfolio to maximize returns given your level of risk. Similarly, EHRs in themselves give you the ability to schedule cases and bill for them. However, that is nearly not enough to actually maximize utilization of block, staffed rooms and prime time. There are a few fundamental issues EHRs do not address:
- Predicting which blocks will not be well used way before day of surgery and nudging clinics to release that time. Meanwhile the way blocks are allocated leads to a culture of ‘scarcity’ with there being no incentives to release time early even when block owners know they won’t be using the time. This leads to a situation where surgeons can find a table for 4 on OpenTable for dinner a lot easier than finding time in the OR.
- Metrics like ‘Block Utilization’ that are used to right-size blocks are fundamentally, mathematically broken and lead to bad decisions and ones surgeons can find all kinds of issues with.
- Reporting and data are often not believed/not shared as broadly as is needed to create a culture of transparency and accountability.
- Many community clinics don’t have access to the EHR and end up capturing their backlog on paper and sending case information by fax and phone.
- The right time to invest in new equipment like robots. Are the current set of robots actually being used to mostly do robotic cases?
- These are some of the issues that scheduling optimization systems, like iQueue for Operating Rooms, solve.
As customers move to our cloud-based supply chain management system, we’ve seen them put an emphasis on using a system like Workday as the source of truth for their item master. From this item master, Workday then sends that data out to all the other systems that need it, like the surgical system and the charge master. Updates, deletions, and adds are all controlled through the item master, meaning that the organization has one process for managing. By centrally managing, the supply chain team is better able to track the supplies and implants being used, encouraging standardization and effective cost management.
On the OR side, having up-to-date, accurate product and cost information from the item master helps ensure that item data on procedure cards is current, accurate, and ready to use, enabling quick documentation via barcode scanning or mobile. Post-surgery, downstream processes like billing or payment for consigned items can flow automatically with no or limited intervention leading to faster, more accurate billing and quicker payments to suppliers.
By having integrated systems, healthcare providers will be able streamline and automate processes, increase revenue capture, control costs, and improve safety through accurate and up-to-date product and price data.
With the increase in supply disruptions and backorders over the past year, it is more critical than ever for health systems to have visibility into planned and anticipated demand. Unfortunately, when it comes to the OR, many supply chain teams don’t get visibility into detailed demand from scheduled cases until orders come in to be picked for the case the next day. But, with the right level of interoperability in a scheduling system, this doesn’t have to be. Since many cases are scheduled 6, 8 , or 12 weeks out, we believe there is great opportunity to leverage advanced planning tools to pull scheduled procedures from the scheduling system along with detailed procedure cards and to forecast out anticipated demand for implants and other items. We’re working with early adopters today to use forecasted demand to compare with expected inventory and anticipate potential shortfalls, allowing plenty of time to adjust ahead of the scheduled case.
ZAGONE: Built-in capabilities to interface with other systems and mobile compatibility are a must, as well as the ability to integrate with ambulatory electronic medical records, lab and radiology as well as physician offices. Surgeon clinic/physician office systems are often overlooked when planning for integration of systems.
In order to provide optimal patient care, organizations must aim for ease of communication between caregivers and the different departments required to coordinate care and plan for the care of surgical patients. The scheduling system is the initial point of entry. From there, the other computer platforms need to be able to bring together everything else required for the day of surgery: Lab work, radiology reports, history and physicals, consent forms and anesthesia plan of care. Once the scheduling is completed, it takes a lot of time, and energy is wasted tracking down these requirements — time and energy better spent caring for patients.
Finally, and often overlooked, is that supply chain needs a line of site for upcoming cases so that supplies and equipment can be made available in a timely, efficient manner. Integrated systems also allow organizations to trace any recalls back to patients more effectively. They also improve accuracy of billing.
[Further] mobile device access is important for surgeons and anesthesiologists for accessing patient documentation.
How might artificial intelligence (AI), machine learning (ML) and/or robotic process administration (RPA) play a role in scheduling systems when it comes to workflow, performance improvement and process efficiency, among other factors?
RECHIN: Some scheduling systems, like ReadySet, are already using AI to help hospitals with things such as identifying non-compliant inventory requests well in advance of the case. AI also drives the unique advanced scheduling algorithms and predictive alerts ReadySet provides. Through these benefits, RSS has helped hospitals as well as device manufacturers by creating benchmarks for forecasting required inventory levels for orthopedic cases, helping hospitals reduce their opened-but-unused tray volume, and also helping device manufacturers limit or reduce inventory levels that just sits in a rep›s garage.
However, there are other AI applications being used in the OR, such as predicting unused block time in ample time to schedule cases. This feature improves a hospital’s OR utilization and is a huge driver of surgeon satisfaction.
SANYAL: AI/ML/RPA in healthcare is in an early stage, but the early results are promising in a few areas:
- Prediction of case length and case volumes, cancelations and no-shows: Helping Operating Rooms predict expected case lengths far more accurately than ‘averages’ of past case lengths can help schedule cases better. Also predicting significant dips or swings in case volumes can both help with ‘over-booking’ and staffing shifts as needed.
- Prediction of the volume and mix of patients and the patient mix in infusion chairs, and clinic exam rooms to be able to optimize patient flow and ‘level load’ the day and staff appropriately.
- Image recognition: Machine-assisted diagnostics that help radiologists and physicians interpret images are showing good results. However, since the biology of each patient is unique, each provider practices medicine in a unique manner and each disease progresses in a unique manner. These technologies will likely need time before they can completely take over a meaningful share of the intelligent decisions that need to be made thousands of times each day in any health system.
In the coming years, healthcare will see what we have seen in other industries – for instance, Uber uses AI and machine learning to ensure they have the right number of drivers in the right locations available for any given city or time of day. We should expect to see intelligent assistants that can construct appointment schedules that utilize the existing scarce resources (e.g., providers, ORs, machines, beds, chairs, etc.) much more efficiently while giving the patients more choices in selecting an appointment slot.
We should also expect to see vastly improved patient flows throughout the health system, manifested by the emptiness of the waiting rooms scattered throughout. These intelligence assistants will be pervasive and yet mostly invisible — they will operate behind the scenes on the application pages used by schedulers to make appointments and will use AI and machine learning to gently and persistently guide schedulers into making better decisions in a timely manner. These assistants will also be prescient -- they will anticipate delays and cancelations and will automatically reroute patients and providers and issue quiet, unobtrusive push notifications to the affected parties while giving them an opportunity to override. Patient flow will resemble a crowded freeway of autonomous vehicles with fully networked communications moving quickly and confidently, adapting as needed without colliding into each other.
These are just a few examples of ‘predictive and prescriptive analytics’ and not just ‘descriptive’ and ‘diagnostic’ analytics that are about ‘see a number, show a number.’ Data science done right can significantly enhance outcomes, increase utilization and access – all while transforming the patient experience.
Where RPA acts like a virtual person, clicking and compiling data as a human would do, artificial intelligence software uses techniques such as machine learning and pattern recognition to help supplement human reasoning on identifying the best or most appropriate workflow, as well as conduct root cause analysis on performance failures and process inefficiencies. RPA and AI can be used to provide more actionable analytics, such as descriptive (i.e., ‘What’s happening now?’), predictive (i.e., ‘What’s the forecast?’), and prescriptive (i.e.., ‘What should we do?’) analytics.
In addition, AI helps to weave in emergency procedures more efficiently into an organization’s schedule. Charge nurses do a great job, but AI can provide additional decision-making support, including historical acuity level data that provides more insight into pre-operative and intra-operative requirements for the case, and relies less on the charge nurse’s ‘experience’ and ‘best guesstimate.’
When considering scheduling systems, ease of use for staff as well as reducing workload is key to improving staff satisfaction and retention. Organizations should be looking at systems that will make staffs’ lives easier.
