Coordinated Scheduling for In-clinic and Virtual Medicine Patients in a Multi-Station Network

Abstract

Coordinated services and virtual medicine are the two innovative concepts being employed in the transformation from provider-centered care to patient-centered care. In this paper, we combine these two concepts to study a coordinated scheduling problem with both virtual medicine patients (VM patients) and in-clinic patients (IC patients) in a multi-disciplinary setting. The problem incorporates these two patient types with differing priorities, heterogeneous service time distributions, distinct cost structures and unique care paths in a multi-station network. We establish priority for IC patients and introduce time windows for VM patients to create flexibility. The problem was motivated by patient appointment scheduling requirements in a multi-disciplinary clinic called an Integrated Practice Unit (IPU). Recursion expressions are derived for a performance measure of interest, which balances revenue against clinic overtime and patient waiting time costs. We develop an approach in which IC patients are scheduled first. To do so, we generate IC patient schedules for a special network structure that are near optimal for a more general network. Conditioned on the schedule of IC patients, we show that the VM patients scheduling problem has a discrete convexity property and can be solved by a local search method even in the presence of non-linear costs. Through numerical examples based on IPUs being implemented by the Dell Medical School at the University of Texas at Austin, we find that the introduction of VM patients can substantially improve system performance and patient access without adding resources.