UX and the ER: The potential of real-time data to cut wait times
by Shane Schick — Feb 5 '14
Before they hooked him up to a monitor, Don Shilton’s heart rate was in the 60s. After conducting a stressful interview, it was surging at 125 beats per minute.
The president of St. Mary’s Hospital in Kitchener, Ont. was taking part in an experiment about the impact of tense situations, but as Shilton explained to the audience at the Mobile Healthcare Summit in Toronto last week, all you really need to do is walk into the average emergency room to see what real stress looks like.
“It’s the No. 1 question that gets asked: How long?” he said. “How long until I get to see a doctor? How long until I get out of here? It’s frustrating for the people at the desks, too, because they don’t always know, and they’re reluctant to give any sense of time.”
Don Shilton,
St. Mary’s Hospital
While much of the discussion about mHealth has focused on the way smartphones, tablets and software can improve the user experience of patients as they are being treated, one of the biggest UX challenges in hospitals involves wait times before they get any care. At St. Mary’s and St. Josepth’s Healthcare in Hamilton, however, the use of real-time data may improve the way both hospitals and patients manage demand for medical resources.
The doctor will see you . . . soon
The two health-care organizations have been working with Oculys Health Informatics Inc., a Kitchener, Ont.-based firm that, in St. Mary’s case, created an algorithm that aims to predict wait times based on historical trend information. According to Shilton, the hospital began a review of existing data in 2011, and only later realized it might make sense to repurpose it for public consumption.
“We thought maybe people would be able to look at that and say, ‘I might want to wait a couple of hours, or go now because it’s going to be longer,’” he said.
St. Mary’s used the data that runs through the Oculys algorithm to present detailed information on its Web site to patients before they make the move to the emergency department (ED). The Web page shows how many patients are being treated, how many are waiting, the estimated time to see a doctor and a graph that shows when the ED will be busiest over the next six hours.
Shilton said the Oculys approach uses behavioural modelling that focuses on “bottleneck” activity, or when the wait times become particularly problematic. This is in contrast to more traditional modelling approaches that look at physician initial assessment (PIA) wait times, or the time it takes to get to see an actual doctor.
“The accuracy was less than 50 percent at first,” he admitted, but over time it has improved substantially. So has the use of the site: Shilton said the wait times portal gets 4,000 to 5,000 visits a month, which is also approximately the number of those who visit the ED in person.
“We thought we would see some of those patients would come at a different time. Instead, there were some who decided not to come at all,” he said. In fact, 70 percent were going to family doctors and 30 percent going to urgent care, based on studies the hospital has conducted since the launch.
“I need to make a big red comment, though, that if you are very seriously ill to call 911,” he added. “We don’t want people who are really, really sick to check the Web site and say, ‘Oh, I’ll wait a little bit.’”
Rooms with a VUE
The situation is similar at St. Joseph’s Healthcare Hamilton, a teaching hospital with 200 beds designated for mental health patients and 700 other beds. In this case, however, the use of real-time data is aimed at helping staff understand when the facility will be reaching capacity and when to move patients from an emergency or operating room, for instance, to a recovery room.
“We have a lot of competing priorities for patient beds and their experiences,” said Jackie Barrett, director at St. Joseph’s.
St. Joseph’s software application, designed by Oculys, is called VUE and uses a colour-coding system to notify staff about patient flow and provide details about how many patients are waiting for beds, how long they’ve been waiting and how many beds are about to become free.
“It has already reduced phone calling between departments because they can see the visibility of the information,” Barrett said.
Oculys president Frank Hivert said the future of real-time data in health is all about better forecasting, an approach sometimes referred to as predictive analytics in the technology space. Hivert likened the evolution to that of cars, where the most important information for drivers used to be contained in the speedometer about how fast they are going. Now, he said, many drivers want to understand where they need to turn left, if there are upcoming obstacles or other delays.
“We want to be the GPS for hospitals,” he said.
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The research opportunity: A recent Fraser Institute report shows that across Canada, wait times are getting worse. How can technology continue to improve the UX of patients?
The commercialization potential: The Canadian Foundation for Healthcare Improvement frequently hosts events and Webinars that explore how real-time data and other technology strategies could transform patient care. Presentations from the most recent eHealth Summit also offer some intriguing ideas.
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