1. Template Building Approaches & Considerations http://catalyst.harvard.edu Open Source Community Call Feb 23, 2016

2. Contents Quick Review – About Visit Templates – System Demo Use Cases Template Building Tips and Tricks 1

3. About Visit Templates Visit templates provide information on – Where the visit is going to happen (Sublocation) – What resources are required for a visit and their order (Resources) – What activities are performed by each resource (Annotations) – Which resources are flexible and how (Standard Alternate, Resource Category – Fixed, Float, Flex) – What the intensity of a resources type’s workload is for the visit (Intensity Levels) – Which resources are billable to the investigator (Billable Resources) Template types: Relative time, Clock time Visit types: Outpatient (Relative Time), Inpatient (Relative or Clock Time) 2

4. How to Set Up a Visit Template System Demo 3

5. Use Case 1: Annotations Use Case: A blood draw can be done by either a nurse or a tech resource. When entering these 2 resources, do I need to enter the “Blood Draw” annotation for both resources? 4 HCCRC Scheduler Advice: In this case tech would be entered as the primary resource, and nurse can be entered as a standard alternate. The “Blood Draw” annotation can be entered for the primary resource, and it would apply to the standard alternate if the alternate were to be reserved for a visit.

6. Use Case 2: Direct vs Indirect Time 5 Use Case: Should the following be added to the template in Scheduler? A patient’s vital signs are taken. The data assessment does not happen in front of the assessment. A patient’s food log information is gathered. The analysis of the food log happens after the patient left the facility. HCCRC Scheduler Advice: We are only using Scheduler to track direct time (direct patient contact) and therefore would add: Taking the patient vital signs Gathering food log information from the patient However, we would not add the vital sign assessment and the food log analysis.

7. 6 Use Case 3: Explicit Call Outs on Activities Question: How do I know which annotations to call out specifically? HCCRC Scheduler Advice: Each institution may have specific resource/annotation needs. HCCRC has a Resource Activity Guide that documents the resources, annotations, and definitions agreed upon by HCCRC sites. Other institutions may consider a similar approach. Examples of activities implied as “part of the job” in which the activity may not be called out: Nurse performs a standard assessment of a patient A resource performs patient teaching tasks Note: A task may not need to be called out if it’s a standard task (e.g. giving meds to patient) unless it’s called out in the protocol Example of a special case in which the activity may be called out: Nurse performs an assessment due to high patient risk or study requiring higher levels of nursing oversight Example of an activity with a broader definition: An annotation encompasses multiple clinical tasks (e.g. our Clamp or Clinical Nursing Care annotations). Sub tasks associated with the annotation should not be entered as separate annotations.

8. Use Case 4: Block vs Granular Task Times 7 Use Case: A nursing resource could potentially see patient(s) during a 6 hour time span, but will only be with the patient(s) intermittently during that time span. Should the resource be booked for the block of 6 hours or booked only at the specific times needed? HCCRC Scheduler Advice: We typically build the template to reflect the actual time needed. For example, if a nurse is needed for 15 minutes every hour, the nurse should be booked for just the time needed. This would help avoid over counting of resource usage and cause artificial blocking when scheduling. Scheduler books in 15 min increments. If a nurse is needed for increments shorter than 15 minutes (e.g. 5 min), a couple of approaches may exist: Round up and book in 15 minute increments (May over count the time needed) Combine the time needed (5min x 6 instances = 30 min) and book a single block for the total time. (May introduce scheduling complications)

9. Use Case 5: Quantities at Activity vs. Resource Level 8 Use Case: A visit needs 2 breakfasts, 1 lunch, 1 dinner. Do I add the resource multiple times or do I add it in once and specify quantity through the annotations? Option 1: Resource: Meal (QTY 4) Annotation: Breakfast (No QTY) Annotation: Lunch (No QTY) Annotation: Dinner (No QTY) HCCRC Scheduler Advice: Based on Program and institution data analysis needs, we chose Option 2 - to specify quantity at the annotation level. Option 2: Resource: Meal (No QTY) Annotation: Breakfast (QTY 2) Annotation: Lunch (QTY 1) Annotation: Dinner (QTY 1)

10. Use Case 6: Billable Portion of a Resource 9 Use Case: A resource is required for 45 minutes, but only 15 minutes are billable. How should the resource be entered into the template? HCCRC Scheduler Advice: The billable portion should be put in as a separate resource. This will be helpful for reporting and as a basis for billing. Suggested structure is: Resource 1: 15 minutes (Marked as billable) Resource 2: 30 minutes

11. Template Building Tips and Tricks At least 1 resource MUST start at 00:00 for relative time If a template only involves a single resource, it must be a fixed resource. Linking float resources only works if the float windows and desired durations of the resources being linked are the same – A template should only include a maximum of 2 linked resource groups (float or flex). More than 2 may affect system performance and speed Flex resources will behave as fixed resources when not in linked groups Make sure to check standard alternates if the resource you are using can be swapped with an alternate Reporting on billable resources is available. Make sure to check “Billable” if resource is to be reported as billable When scheduling, 10 Always start with room (if applicable—or the most rate-limiting resource if no room is involved) and work from there chronologically. OR Always start with room (if applicable—or the most rate-limiting resource if no room is involved) and then add any known high-demand, rate-limiting resources regardless of chronology.