rufus daniel - hawks
TRANSCRIPT
HAWKS- a pre-consultation kiosk for patients with URTI
Pilot - Woodlands Polyclinic
Phase 1 ( May 2012 )
Managing the load : lane traffic ?
Over 650 walk-ins a day
Almost 150 – 200 of them having URTI
What if we separate them, send them to 2 or 3
rooms ? They would be seen faster, and leave
the clinic faster.
Better yet, what if I could pass on the information
I get from them ( while segregating them ) to the
end user : the doctor ? More time saved !
# Work Sequence Standard
1 Screen at ATT Kiosk Ask Pt:
1. Sir / Mdm, do you have Cough, Cold, Flu, Fever, Sore Eyes or Diarrhea?
2. If Pt has Flu, Fever, Sore eyes or Diarrhea scan IC for Q ticket & direct to Screening 1
Station
2 Screening 1 Station (URTI Symptoms / Diarrhoea / „Sore Eyes‟ Patient ONLY)
1. Check Temperature
2. Write temperature on Q Ticket
3. Handoff Pt to Screening Staff
3 Screening 1 Declaration Ask Pt:
1. Are you here for a Referral or Long Term Medication
2. Any Cough, Running Nose or Sore Throat
3. Any Fever
4. Any Diarrhoea
5. Any „Sore Eyes‟
6. Does he need a Medical Certificate (If no, refer to OTC)
Direct Pt to Waiting Area & wait for Reg Counter 1 or 2 to call.
4 Exchange 2XXX with 5XXX Exchange Queue Ticket
1. Patient eligible for Blue Cluster to exchange 2XXX Queue number with a 5XXX
2. Staple a 5xxx number together with the 2xxx number. Ask patient to hold on to a
duplicate 5xxx Q number.
3. Ask patient to drop off the stapled 2xxx and 5xxx on a tray at the dedicated counters
4. Ask patient to wait for his 5xxx number to call to be registered.
Screening and Registration Recipe Card
Recipe Card (Cont.)# Work Sequence Standard
5 Registration Counter Ask Pt:
1. Call 5xxx Pt on Q panel
2. Collect Pt 5xxx Q ticket
3. Pt Identifier
4. Sir/Mdm I‟m going to ask you some questions to make your Dr visit smoother
5. Do you have any other complaint that requires attention by the Dr?
6. Are you here to request a hospital referral?
Patients who answer YES to 5 or 6, assign to normal acute cluster Dr
6 Reg – URTI Patients Ask Pt:
1. Have you had fever for more than 4 days?
2. Have you had fever >38C during this illness?
3. Do you have Diabetes, Stroke, Heart or Lung Disease or are you taking any medicine for cancer?
4. Any history of Asthma?
5. Document all information into PSA template
7 Reg – Keying into Enotes Enotes
1. Copy & Paste Standard Template into Pt‟s Enotes Free Text
2. Edit the information in the template according to the answers given by the patient
3. Save the information keyed into Free Text
8 Reg - Closing 1. Assign Patient to Blue Cluster Dr
2. Print out Service Chit
3. Give Patient Service Chit
4. Direct Patient to L2 Blue Cluster
Project Overview
A self-help kiosk for patients to Answer basic health questions relating to medical history and
clinical symptoms related to URTI
Measure vital signs
Upon patient being called, transfer all answers directly into doctors electronic notes
Future Application Allow remote consult during pandemic outbreaks
Allow patient education to take place and improve health literacy level
Current Condition
Proposed Flow (Pilot Phase 1)
Note:
1. Patient has to be registered for visit
info to be “fired” to all downstream
interfaces.
2. 5xxx series number acts a sequencer
for dedicated Registration
3. Kiosk would be aided by a HA during
initial pilot phase.
Patient scans /
keys in MRN
No.
Q-Ticket
generated
(2XXX
Series)
Does
patient has
URTI?
Patient waits
Counters 3-5
for
Registration
Patient
presents at
Pre-Reg
Kiosk
Staff registers
and assigns
patients to
Non-URTI
Cluster
Dr sees patient,
prescribes
medication and
enters consult notes
in Aurora
Patient goes to
Pharmacy for
prescription/payment
Patient issued 5XXX
series Q-No and waits
for Dedicated Reg
Counters 1-2
Counters 1-2 calls 5XXX Q-
No. to register/assign patient to
Rms 46-47 “Blue Zone” and
directs patient to HAWKS
Kiosk
Patient begins
answering HAWKS
Kiosk Questions
HAWKS Kiosk
determines if patient
eligible for “Blue
Zone?”
Patient is sent back
to Counters 1-2 to
be reassigned to
another cluster
Patient’s
Temperature/Weight
taken by HAWKS
Kiosk and Data
gathered from Kiosk
flows to Aurora
Patient proceeds to
wait at “Blue Zone”
waiting area for
Consultation.
“Blue Zone” Doctor calls
patient and opens patient’s
clinical notes with
HAWKS data and
proceeds with consultation.
Y
N
Y
N
Changes made
in Pilot Phase
End
End
Patient scans /
keys in MRN
No.
Q-Ticket
generated
(2XXX
Series)
Does
patient has
URTI?
Patient waits
Counters 3-5
for
Registration
Patient
presents at
Pre-Reg
Kiosk
Staff registers
and assigns
patients to
Non-URTI
Cluster
Dr sees patient,
prescribes
medication and
enters consult notes
in Aurora
Patient goes to
Pharmacy for
prescription/payment
Patient issued 5XXX
series Q-No and waits
for Dedicated Reg
Counters 1-2
Counters 1-2 calls 5XXX Q-
No. to register/assign patient to
Rms 46-47 “Blue Zone” and
directs patient to HAWKS
Kiosk
Patient begins
answering HAWKS
Kiosk Questions
HAWKS Kiosk
determines if patient
eligible for “Blue
Zone?”
Patient is sent back
to Counters 1-2 to
be reassigned to
another cluster
Patient’s
Temperature/Weight
taken by HAWKS
Kiosk and Data
gathered from Kiosk
flows to Aurora
Patient proceeds to
wait at “Blue Zone”
waiting area for
Consultation.
“Blue Zone” Doctor calls
patient and opens patient’s
clinical notes with
HAWKS data and
proceeds with consultation.
Y
N
Y
N
Changes made
in Pilot Phase
End
End
Workflow – simplified view
Patient Obtains No. from ATT
Waits for Registration with General Pool
Maintains room assignment and consults
Acute VSM Doctor
Sent to Hawks Kiosk
Passes Acute VSM Criteria
Fails Acute VSM Criteria,
sent back to PSA &
reassign to Acute Cluster
PSA asks for purpose of visit
Dedicated PSA Registration &
assigned to Acute VSM Doctor
URTI
Complaints
Other
Complaints
Patient has to
be registered
before data
from kiosk
can flow to
Aurora
HAWKS Kiosk Questionnaires
Reiteration Question
1) DO YOU HAVE COUGH, RUNNY NOSE, SORE THROAT
WITH/WITHOUT FEVER ? ( Yes - Proceed. No - Exit from kiosk flow )
Exit Questions
1) DO YOU HAVE ANY COMPLAINTS OTHER THAN COUGH/RUNNY
NOSE/SORE THROAT +/- FEVER ? ( No - Proceed. Yes - Exit from kiosk
flow )
2) DO YOU NEED A REFERRAL OR DO YOU NEED TO 'TOP-UP' YOUR
(CHRONIC) MEDICINES ? ( No - Proceed. Yes - Exit from kiosk flow )
3) ARE YOU PRESENTLY TAKING ANY MEDICINES/INHALERS FOR
ASTHMA ? ( No - Proceed. Yes - Exit from kiosk flow )
HAWKS Kiosk Questionnaires
Actual data gathering at the Kiosk
(Data has to flow in sentence format to “Subjective Section” of the Doctors eNotes)
1) DO YOU HAVE COUGH ? IF YES, FOR HOW MANY DAYS ?
2) DO YOU HAVE RUNNY NOSE? IF YES, FOR HOW MANY DAYS ?
3) DO YOU HAVE SORE THROAT ? IF YES, FOR HOW MANY DAYS ?
4) DO YOU HAVE A FEVER ? IF YES, FOR HOW MANY DAYS ?
5) DID YOU CHECK YOUR TEMP AT HOME ? WHAT WAS THE
MAXIMUM TEMPERATURE DURING THIS ILLNESS? ____
6) PRESENT TEMP ___ C
Appearance in „e-notes‟
Final appearance by Phase 2 would be grouping of
symptoms according to duration, with longest mentioned
first; for eg :
“ Runny nose and Cough for 4 days”
“Sore throat for 2 days”
“Fever for 1 day”
Another example:
“Runny nose and Sore throat for 3 days
No cough. No fever.”
Timeline
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Phase 2 and ongoing
HAWKs Kiosk to be interfaced with ePOS to
assign patients to appropriate consultation
clusters/rooms without human intervention.
(Future State)