For a computer to take the place of a scheduling expert, the computer program has to think just like a scheduler does.
The first requirement is a thorough awareness of the personnel, facilities, equipment and supplies available at any one time.
Then those resources have to be brought together in the appropriate combination, in the right order and with the right spacing to get a procedure or test series done-taking into account personal preferences of physicians.
After a patient shows up for treatment, the scheduler has to consider the work that was completed, then use departmental rules and clinician instructions to determine what follow-up appointments to make.
"All the things they think through*.*.*.*you have to find a way to codify it," said Mark Rafferty, product manager for HBO & Co.'s Pathways Healthcare Scheduling, one of a number of information systems on the market to coordinate resources across multiple-site networks.
The sophisticated software of a scheduling system tries to mimic the way a human mind would reach back into memory-its "database"-and logically line up a regimen of diagnostics and treatment, Rafferty said.
For example, a scheduler would know an X-ray procedure that depended on a contrast agent wouldn't be scheduled before reserving the appointment needed to get the necessary injection. And the physician consultation would be useless unless it came after the other appointments.
Vendors hawk a laundry list of functions that can be loaded with instructions that define rules and requirements for procedures, "telling the system what an expert scheduler knows already and allowing a nonexpert to do it," Rafferty said.
The software watches for scheduling conflicts, searches for the best available time slots and locations for a progression of appointments, and leaves a pre-established amount of time in between for transport.
The catch is the software must include every nugget of working knowledge, every rule that's followed by a scheduler as if it's second nature. Any consideration overlooked in the programming also will be overlooked by the system's automated deliberations.
Rafferty said the rules process likely will be revised and supplemented once the scheduling system becomes operational. "You're not going to be able to do the whole thing right off the bat," he said. The use of the system by workers will uncover omissions: "If you're missing a rule, you put it in."
Getting the initial programming in shape is just the start, said Aarne Elias, managing associate with the healthcare practice of Coopers & Lybrand. "There's a lot of maintenance to be done to keep all the guidelines current."
At Deaconess Incarnate Word Health System in St. Louis, a scheduling system has supplied a powerful assist to a central appointment office that had been trying to coordinate scheduling manually (See related story, p. 64). But Pat Brennan, director of systems integration, emphasized, "It's only as good as the effort we're making to keep it accurate and up-to-date." The appointment office gets notices of needed changes on a daily basis, he said.
Programming the rules is a policy process as well as a technical issue. That's because it determines everything from the resources included in a particular procedure to the amount of leeway a scheduler has to craft custom situations when called for, experts said.
And the rules built into the process have to strike a balance between covering all the considerations and keeping the routine from getting ridiculously complex, Elias said. "It's tough to go through a list of 100 questions every time you schedule something."
As important as rules construction is to the process, it's only the beginning of the workload. The scheduling instructions aren't any good without schedules to work with.
Lahey Clinic Medical Center in Burlington, Mass., devotes 5.5 full-time-equivalent staffers to the task of putting together schedules, said Linda Cagle, director of the central appointment office.
Those schedulers create the templates for slotting the time and determining the workloads of more than 400 clinicians and 28 departments.
Industry experts stress the importance of being prepared organizationally for systemwide scheduling, but there's also a technical side to the preparedness, said Michael Kreitzer, national director of systems integration services for Coopers & Lybrand.
Scheduling doesn't work in a vacuum, he said. It needs to tap into other information systems for crucial data on patients and hospital resources, such as patient-accounting and registration systems.
In addition to making sure existing information systems can be integrated, Kreitzer said other new types of information-system components should be prerequisites to the installation of an appointment and resource scheduling system.
Without a managed-care information system, for example, the scheduling process won't be able to weigh the impact of insurance coverage and pre-authorizations on the scheduling of tests and treatments, Kreitzer said.
Without a system known as a master patient index, the scheduling system won't have a means of communicating among a disparate base of information systems from newly affiliated partners, all with information on patients but with different ways of identifying them, he said.