1. HCCRC Scheduler System
Harvard Catalyst Clinical Research Center

2. Agenda Overview
Web-base application currently running at four hospitals with clinical research centers supported through the Harvard Catalyst
Application’s Purpose
Scheduling
Helps investigators and study coordinators efficiently schedule directly with subjects
CRC Admin
Provide detail in resource utilization and resource management
Information regarding study and subject visit history

3. Agenda Overview
Web-base application currently running at four hospitals with clinical research centers supported through the Harvard Catalyst
Application’s Purpose
Scheduling
Helps investigators and study coordinators efficiently schedule directly with subjects
CRC Admin
Provide detail in resource utilization and resource management
Information regarding study and subject visit history

4. Scheduler Overview
The Scheduler Application collects clinical research activity for analysis for study and resource activity

5. Scheduler Overview = + web-based same app at each HCCRC institution
HCCRC Scheduler Application =
Scheduling +
Clinical Research Center Administration
web-based
same app at each HCCRC institution
reduce the time spent to schedule a subject for a study visit
review visit activity and resource utilization across CRC sites
efficient resource management
Web-base application currently running at four hospitals with clinical research centers supported through the Harvard Catalyst
Application’s Purpose
Scheduling
Helps investigators and study coordinators efficiently schedule directly with subjects
CRC Admin
Provide detail in resource utilization and resource management
Information regarding study and subject visit history

6. Our problem: Scheduler Overview
Traditional scheduling methods can cause workflow bottlenecks that limit the utilization of clinical research resources.
Difficult to capture the complexity of scheduling multiple resources and potential combinations of resource order to accommodate a study visit.
Traditional Method
Coordinator reviews with different resource groups that manage rooms, study staff and equipment
The complex environment of the clinical centers creates high demand for resources with very limited availability
Takes a lot of time and effort to find the different combinations that resources can fit within a desired time period

7. Our solution: Overview
Users can define and setup the availability and quantity of their resources.
Scheduler System uses a visit template that identifies the resources and the ideal time(s) these resources will be used in a typical visit.
Captures the complexity of scheduling multiple resources in parallel.
Takes advantage of all the possible resource combinations to accommodate a study visit for a desired time.
Allows study teams to directly schedule subjects.
Developed an application that allowed administration to define resource availability for all resources across different clinical research locations in the hospital
Visit Template
Study protocols contain visits that often have a standard, repeatable order of resources and processes
Outline/Guide of the resources needed for a study visit and their duration and order in time

8. Visit Template Fixed Resource Flex Resource Float Resource Float Group
Visit Template in the Application
Timeline that graphically represents how resource “building blocks” will be used.
00:00 indicates the very beginning of the visit.
Resources can be defined as
Fixed Resources: Set start and end time and will occur throughout
Float Resources: Desired start and end time (highlighted in dark purple) that can “float” along a larger time window (in light purple shade) for increased options.
Float Resources can be grouped into Float Groups in which both resources in a float group have to be available.
Flex Resources: Resources that can flip the order with its pair if either resource is unavailable.
Float Group

9. Resource Availability
Appointment Flow
How does it work?
The system’s algorithm takes the visit template and compares the resources in the template to the general availability of the resources and the already booked visits in the calendar for the desired search range
Scheduling Algorithm
Booked Visits
Resource Availability
Visit Template
Search Range
Available Visit Times?
Appointment Search
Overview of Scheduling Algorithm
User selects the visit template and desired search range
Application reviews resource availability for the visit template
Application will display available appointment blocks in real time

10. Reports
CRC Administrative Leaders can generate reports from the booked visits to analyze:
Resource Utilization
Resource Activity
Study Activity
Site Activity
Cancellations
Billing
The Scheduler Application collects clinical research activity for analysis for study and resource activity

11. Open Source Scheduler is an open source software
The Open.Med site contains information on:
Scheduler overview
Scheduler Sandbox
Download and install instructions
Technical and user documentation
Rollout and operational documentation
License and copyright information
The Scheduler Application collects clinical research activity for analysis for study and resource activity

12. Rollout Overview
The Scheduler Application collects clinical research activity for analysis for study and resource activity

13. Sample Rollout Checklist

14. Major Rollout Phases and Activities

15. Sample Small Institution Rollout Timeline

16. Data Migration (ETL) Approach Scheduler Roll-Out at HCCRC Institutions

17. State of Data at the Institutions
Varying methods for scheduling used at each of the four CRCs
Methods include:
Paper and pencil (scheduling book)
Turbo software
Outlook
Epic
Each method yielded different levels of available data in varying formats

18. Data Loaded into Scheduler
Scheduled visits
Each visit was put in as an overbook
Subjects
Resource intensities added to existing visit templates
Notes
Prior to data migration, studies and visit templates were modeled out and then built directly in the system, resources were added directly to the database
For some sites, we were able to move data over programmatically. For other sites, we decided to enter certain data manually based on:
Levels of effort for each approach
Data available
Developer and operational staff availability

19. Approach to ETL
Established formats in which each institution would provide their data
File format (CSV) and layout
Data formats (e.g. dates, strings)
Required close communication, trial and error with Harvard Catalyst engineers and institution engineers
Coded a program to extract institution data from the CSV files and transform it into our domain objects
Created a code branch with a copy of Scheduler code used to populate the database
Send sample data (no PHI)
Code program, including proper validation messages
Run the program on a test system and report errors
Engineer at Institution
Harvard Catalyst Engineer

20. Challenges & Lessons Learned
Because we are outside of the hospital and there is sensitive patient data, we were only able to utilize sample data when coding and testing
This caused a lot of back and forth between engineers at Harvard Catalyst and at the hospital
The method used to populate the Scheduler database is not re-usable and was a one-time effort

21. Data Set Up Flow
The Scheduler Application collects clinical research activity for analysis for study and resource activity

22. Data Flow

23. Ref. Letter
Table(s) A
sublocation B
resource
resource_annotation
line_level_annotations
resource_type
resource_sublocation C
resource_schedule
resource_alternate D
sublocation_closure_interval E
user F
study_user G
study H I J
visit_template
template_resource
template_resource_annotation K
template_approval_history L
subject M
study_subject

24. Template Building
The Scheduler Application collects clinical research activity for analysis for study and resource activity

25. About Visit Template Visit templates provide information on
What resources are required for a visit and their order (Resources)
What activities are performed by each resource (Annotations)
Where the visit is going to happen (Sub location)
What level of intensity the resources will be used (Intensity Levels)
What resources are billable to the investigator (Billable Resources)
Template types: Relative time, Clock time
Visit types: Outpatient (Relative Time) , Inpatient (Relative or Clock Time)
Resource types: Fixed, Float, Flex

26. Template Building Demo
The Scheduler Application collects clinical research activity for analysis for study and resource activity

27. Use Case 1: Annotation
Use Case: The task of verifying informed consent can be done by either a nurse resource or a research dietician resource. When entering these 2 resources, do I need to enter the “Verify Informed Consent” annotation for both resources?
HCCRC Scheduler Advice: If a task can be performed by multiple resources, the annotation does not need to be entered for all of those resources. Only the resource performing the task need to have the annotation.

28. Use Case 2: Direct vs Indirect Time
Use Case: Patient vital signs are taken by a PCT (Template Resource: PCT; Task: ”Vitals – Simple”). Nurses typically assess the data from all vitals taken by a PCT, in most cases this does not happen in front of the patient. Is this considered indirect time? Should nurse be added as a resource or assessment as an annotation?
HCCRC Scheduler Advice: In this case nurse should not be added as a resource. Assessment should not be included as an annotation. Neither should be included in the template.
Scheduler is only for direct time.

29. Use Case 3: Explicit Call Outs on Tasks
Question: When should a task be specifically called out as an annotation, vs considered part of the definition of a resource’s job?
HCCRC Scheduler Advice: Each institution may have specific resource/annotation needs. HCCRC has a Resource Activity Guide that documents the resources and annotations agreed upon by HCCRC sites. Other institutions may consider a similar approach.
Examples:
Nurse performs a standard assessment of a patient
Performing a standard assessment is part of a nurse’s job and should not be called out as a separate annotation.
Nurse performs an assessment due to high patient risk or study requiring higher levels of nursing oversight
This task is different from a standard assessment. Do not use the annotation “Assessment”, instead use annotation” Special Protocol Procedure”
A resource performs patient teaching tasks
No need for annotation unless the teaching is beyond the resource’s normal tasks.
An annotation encompasses multiple clinical tasks
All sub tasks associated with the annotation should not be entered as separate annotations.

30. Use Case 4: Block vs Granular Task Times
Use Case: A nursing resource could potentially see patient(s) during a 6 hour time span. But with the patient(s) intermittently instead of for the entire duration. Should the resource be booked for the block of 6 hours or booked at more granular time intervals?
HCCRC Scheduler Advice:
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 artificial blocking when scheduling.

31. Use Case 5: Quantities at Activity vs. Resource Level
Use Case: A visit needs 2 breakfasts, 1 lunch, 1 dinner
Option 1:
Resource: Meal (QTY 4)
Annotation: Breakfast (No QTY)
Annotation: Lunch (No QTY)
Annotation: Dinner (No QTY)
Option 2:
Resource: Meal (No QTY)
Annotation: Breakfast (QTY 2)
Annotation: Lunch (QTY 1)
Annotation: Dinner (QTY 1)
HCCRC Scheduler Advice:
The choice can be institution specific, depending on the data analysis needs. Operationally, whether it is helpful to an institution to track quantity at the resource level or the annotation level would help determine the approach.

32. Use Case 6: Billable Portion of a Resource
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 billing analysis and reporting. Suggested structure is:
Resource 1: 15 minutes (Marked as billable)
Resource 2: 30 minutes

33. 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,
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.
Reference: Scheduler Resource Activity Guide: