Waiting Rooms, Big Data, Overbooking, and Chickenpox

Business|Data Science| January 08, 2016| Florian

I have a definite phobia about doctor's waiting rooms. This phobia came about fairly recently, after contracting chickenpox, a disease I attributed to spending some time in a pediatrician's waiting room (of course, there is no certainty that I actually caught chickenpox in a waiting room, but it's always reassuring to assign a known cause to unpleasant events).

Chickenpox is a very serious illness for adults - several days of intense fever, and hundreds of irritating spots that can each become scars. In any case, this has often led me to ask me the question:

How are medical appointments made? How is it that waiting rooms are filled up?

The doctor: knowledge based on experience

The waiting room of a doctor in Paris is often managed by a medical secretary.

My doctor, or actually his medical secretary, once explained to me how he managed the doctor's schedule. He uses a system of common sense rules. He described it to me as follows

  • I know that on Monday morning we will have a certain type of patients, who want to take their time. So I plan for appointments to go a little longer.

  • I know that so-and-so will not be at the appointment one in three times

  • People arrive late more often when you schedule appointments on the half-hour than on the hour. I think of that from time to time

  • At the end of the week, I know that the doctor needs more calm on Friday in the late morning before starting the weekend

  • etc..

In short, my Parisian doctor's schedule is optimized by twenty years of human experience!

The healthcare center and its call center

On the contrary, taking appointments in the New York healthcare center, which I was (briefly) able to experience, is quite different:

  • All calls are made to a centralized call platform.

  • The doctor who will take the appointment, or the reason for the consultation are not known when the appointments are made

  • Appointments are organized in a very standardized way: 3 appointments per hour, with a small break between each one (a bit like the commercial breaks in a TV show)

After a quick interview with the receptionist at the center, the scheduling process does not employ advanced technologies: email, and positioning in a shared Outlook calendar.

In short, it's the darker side of digitalization: a platform that connects efficiently and anonymously, but foolishly as a result.

Can data help?

These findings lead to another question:

How can the healthcare industry improve its scheduling efficiency planning?
Can data help?

From my point of view, this involves two approaches:

  • First, healthcare practitioners and small healthcare centers can adopt appointment management platforms, such as iatrico.com, queuedr.com, or doctolib.fr. These make it possible to better manage patient reminders, cancellations, etc.

  • Larger healthcare centers and networks can implement platforms giving them better knowledge of their patients. Modeling patient behavior would make it possible, among other things, to anticipate "no-shows" or better control the time scheduled for the appointments.

Without compromising anonymity and the need to respect privacy that presides over any project in the healthcare field, a healthcare network could use the data to:

  • Make patient routing systems, to prioritize the most urgent cases

  • Plan for seasonal epidemics in advance, in order to anticipate the needs of patients

  • Better anticipate patient no-shows, to construct, perhaps, approaches similar to those used in civil aviation (over-booking)

For more information on this subject, Dataiku has written a free eBook that describes the techniques to be used to construct these models (EPUB or PDF Format, 40 pages)

Free Ebook Healthcare Dataiku
"Advanced Analytics for Efficient Healthcare"

Epilogue: Why is chickenpox more severe in adults?

As I explained, my phobia of waiting rooms came about after contracting chickenpox at the age of 30.

The effects of chickenpox vary greatly depending on the age of the patient. Simultaneously, my 4 year old got away with just a few spots barely visible to the naked eye, while my 6 year old came down with a fever for a few days and visible spots, and, as for me, I had the joy of experiencing an impressive eruption, all over my body, of lasting, irritating spots and a fever that lasted or ten days, which then gave way to the scabs, then potential pockmarks.

There seems to be no scientific consensus on the reasons why chickenpox is more severe in adults, and several hypotheses have been put forth:

  • Either there is a stronger immune response in adults, related to a more developed immune system

  • Or the opposite, a weaker immune response in adults

  • Or lastly, statistical biases: those who have not had chickenpox as a child are more likely to have natural immunity and therefore the disease corresponds to a moment of immune system weakness or to a more aggressive strain of the virus.

Another mystery that further analysis may one day be able to solve.

Or not

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