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The purpose of this paper is to analyze challenges in a real-world implementation of simulation model based workflow improvements. 10 As expected, there were challenges in implementing the new template, but when it was followed, there were reductions in average patient wait times and clinic session lengths. We implemented a new scheduling template in one outpatient ophthalmology clinic (LR) at OHSU starting in September 2016 after preliminary studies demonstrated its effectiveness. New scheduling templates disrupt these practices and priorities, which can make following new schedules challenging. Clinic staff become adept at navigating clinic schedules, ensuring that all urgent patients are scheduled and appointment slots are filled, including those that are last-minute cancellations. While efficient workflow is a priority in outpatient clinics, so is filling all appointment slots and serving urgent walk-in patients. While simulation models can predict improvements with new scheduling templates, implementing them in clinic faces real-world challenges such as competing clinic priorities, and established scheduling practices. 8 These models, along with prior research, confirm that scheduling longer encounters with higher variability at the end of the day helps reduce wait time.
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7 Previous work has demonstrated that EHR timing data can be used for building clinic simulation models for studying scheduling templates before implementing them in the clinic. This mismatch of arrivals and availability can be caused by ad-hoc scheduling protocols that increase patient wait time. 6Ĭlinic inefficiencies result when patients arrive and clinic resources (staff, exam rooms, and providers) are not available to serve them. 3– 5 For example, at Oregon Health & Science University (OHSU), which completed a successful EHR implementation in 2006 that received national publicity, ophthalmologists currently see 3-5% fewer patients than before EHR implementation and require >40% additional time for each patient encounter. 1, 2 Furthermore, clinicians are concerned that the adoption of electronic health records (EHRs) has negatively impacted their productivity. Physicians today are pressured to see more patients in less time for less reimbursement due to persistent concerns about the accessibility and cost of healthcare.