Electronic Visits in Primary Care: Modeling, Analysis, and Scheduling Policies.

PATIENT management; WEB services; PRIMARY care; SCHEDULING; PHYSICIAN-patient relations

Primary care, the backbone of the nation’s healthcare system, is at the risk of collapse. Patients are dissatisfied due to poor access to care, and physicians are unhappy and burning out with an enormous amount of tasks. To improve the primary care access, many healthcare organizations have introduced electronic visits (or e-visits) to provide patient-physician communications through securing messages. In this paper, we introduce an analytical model to study e-visits in primary care clinics. Analytical formulas to evaluate the mean and variance of the patient length of visit in primary care clinics with e-visits are derived. System properties are investigated. In addition, comparisons of different scheduling policies between the office and the e-visits are carried out. The first come first serve, preemptive-resume, and non-preemptive policies are studied and the results show that the first come first serve policy typically leads to the best performance.

Note to Practitioners—The primary care delivery system is under a lot of strain. Due to population growth and aging, and the expanded healthcare insurance coverage, the demand for primary care services has increased substantially in the past years. Patients have difficulty of getting timely access to care, while primary care physicians are facing insurmountable tasks. Electronic visit, or e-visit, as an alternative to the traditional office visit, provides an innovative way of patient-physician communication through securing messages. The successful implementation of e-visit relies on a proper understanding of the impact of e-visit on care access, and an appropriate design and scheduling of workforce and operations. Therefore, the objective of this paper is to develop an analytical model of the primary care delivery with e-visits, using which one can investigate the impact of e-visits on patient accessibility. In particular, the average value and variance of patients’ length of visit for their encounters are evaluated. Different policies for physicians to schedule office and e-visit patients are compared. In addition, physicians’ nondirect care activities, such as billings and documentations, are also considered in the model. [ABSTRACT FROM PUBLISHER]

Copyright of IEEE Transactions on Automation Science & Engineering is the property of IEEE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)