rufus daniel - hawks

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HAWKS - a pre-consultation kiosk for patients with URTI Pilot - Woodlands Polyclinic Phase 1 ( May 2012 )

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Page 1: RUFUS DANIEL - HAWKS

HAWKS- a pre-consultation kiosk for patients with URTI

Pilot - Woodlands Polyclinic

Phase 1 ( May 2012 )

Page 2: RUFUS DANIEL - HAWKS

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 !

Page 3: RUFUS DANIEL - HAWKS

# 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

Page 4: RUFUS DANIEL - HAWKS

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

Page 5: RUFUS DANIEL - HAWKS

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

Page 6: RUFUS DANIEL - HAWKS

Current Condition

Page 7: RUFUS DANIEL - HAWKS

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

Page 8: RUFUS DANIEL - HAWKS

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

Page 9: RUFUS DANIEL - HAWKS

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 )

Page 10: RUFUS DANIEL - HAWKS

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

Page 11: RUFUS DANIEL - HAWKS

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.”

Page 12: RUFUS DANIEL - HAWKS

Timeline

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Page 13: RUFUS DANIEL - HAWKS

Phase 2 and ongoing

HAWKs Kiosk to be interfaced with ePOS to

assign patients to appropriate consultation

clusters/rooms without human intervention.

(Future State)