Orchestration software at busy Brampton clinic results in quick improvements

Queen Square Doctors (QSD), a large and busy primary care clinic in Brampton, Ontario, partnered with CHIME Technology Inc. to address rising overhead costs and operational inefficiencies.

With support from the Innovating Digital Health Solutions (IDHS) Program, the Ontario Centre of Innovation, and the Ministry of Health, QSD implemented CHIME, an intelligent clinic orchestration platform.

Preliminary results after three months evidenced gross annual cost savings of over $160,000, roughly a 500 percent return on investment. Additional cost savings are possible as the use of the system expands and matures.

A comparison of pre- and post-implementation metrics revealed improved efficiency, staff satisfaction, and patient satisfaction. A key and surprising case study learning was to deploy the full system quickly, instead of incrementally.

“CHIME has been the biggest improvement that Queen Square has ever made,” commented Shelly Medeiros, director of operations, Queen Square Doctors.

This case study has demonstrated that CHIME can be successfully implemented in existing clinics like QSD to achieve multiple pillars of the Quadruple Aim of better care, better experience for staff and clients alike, all at lower cost. The magnitude of the savings achieved illustrate that CHIME is a scalable model that can contribute to the sustainability of the public healthcare ecosystem.

Queen Square Doctors (QSD) is a 36-exam room primary care clinic located in Brampton, Ont. It hosts 19 family physicians and three registered practical nurses, along with other interdisciplinary healthcare providers, who collectively care for 30,000 patients.

Prior to this case study, these clinicians were supported by a team of four medical assistants (also known as “runners”), included within a complement of 26 administrative staff. QSD faced the same financial pressures of other clinics within primary care. In response, they have been leaders in finding and implementing solutions that reduce costs while improving care and experience.

For its part, CHIME Technology Inc. is an Ontario based company that develops and deploys a clinic orchestration platform. It was designed in collaboration with clinicians and clinic operators to address key financial and operational challenges faced by clinics like QSD. CHIME has been successfully deployed to numerous newly built clinics, but there have been few opportunities to demonstrate a meaningful improvement in an established organization.

The Innovating Digital Health Solutions (IDHS) Program was funded by the Government of Ontario and administered by the Ontario Centre of Innovation on behalf of the Ministry of Health and Ontario Health. This program supported the deployment of CHIME to QSD with the key goals noted above.

CHIME is a clinic orchestration system – deployed on a variety of tablets, screens, and kiosks – that coordinates and automates its real-time day-to-day operation. This platform is analogous to restaurant technologies used by hosts, waiters, and kitchen staff to coordinate seating guests, taking orders, and delegating kitchen duties. The cornerstone of this platform is tracking and using the real-time status of clinicians, staff, patients, and rooms to achieve improved user journeys, as noted below.

• Patient User Journey: A patient enters the facility; checks-in via a kiosk, sits down; sees their name and wait time on a waiting room screen; is automatically assigned to a clean exam room; is informed via visual and audio cues to proceed to their assigned room.
• Medical Assistant User Journey: A medical assistant is doing admin work on a computer; a tablet pings to say a patient in room 5 needs prep; they proceed to room 5, and check into the room via a wall-mounted tablet; they prep the patient in the room; they check-out of the room via the same wall-mounted tablet; the wall-mounted tablet tells them there’s another patient in room 7 that needs to be weighed; the medical assistant proceeds to room 7.
• Physician User Journey: A physician sees their patient in room 3 has been prepped and proceeds there; the wall-mounted tablet outside the room reminds the physician that PPE is recommended given this patient’s chief complaint; the physician checks-in via the tablet; when done, the physician uses the wall-mounted tablet to “add shots” for this patient; the wall-mounted tablet tells them their next patient is in room 9.
• Manager User Journey: A clinic manager is deciding whether there is room for another family doctor on Monday afternoons. The technology advises Monday afternoons are only running at roughly 70 percent capacity of Wednesday mornings, and concludes there is room for another family doctor to see patients on Monday.
• Evaluation metrics: For the purpose of this case study, seven specific evaluation metrics were identified in collaboration with QSD. These metrics were identified prior to deployment of CHIME for the purpose of obtaining a suitable evaluation baseline so that a validated outcome could be measured. A summary is included below.
• Would there be a measurable financial impact? At least $160,000 annually, or a 500+ percent annual return on investment.
• Would support tasks be measurably automated? 87 percent of patients checked-in via a kiosk 94 percent of patients were automatically roomed.
• Would clinic nuances be accommodated? Yes, via qualitative and anecdotal measures.
• Could internal staff be retrained and redeployed? Yes. Frequency of average patient phone wait hold times exceeding five minutes reduced from four days monthly, to zero. 12 percent increase in administrative tasks completed per week by support staff.
• What would be the staff experience? Clinic support staff perceive improvements across the board. Four out of five support staff perceive a reduction in daily stress.
• What would be the physician experience? Clinic physicians perceived benefits primarily in the areas of staying on time and overall patient flow. One out of five physicians perceived a reduction in daily stress.
• What would be the patient experience? Three out of four patients advised they were happy or very happy with the kiosk self-check in experience. Only one out of 10 were very unhappy. Four out of five patients advised they perceived the estimated wait time feature to be useful or very useful.

The evaluation period began January 1, 2024 and continued uninterrupted until March 31, 2024. Use of the actual system has continued post April 1, 2024 and there are no plans to stop its use.

Financial Impact: Given the financial pressures on primary care, this evaluation metric was the single most important consideration. CHIME traditionally advertises two types of financial impact: 1. By automating tasks, staffing needs can be reduced, thereby reducing operating costs. 2. By reducing the per MD usage of exam rooms, more clinicians can see more patients from the same physical real estate.

Operating Costs: During the evaluation period, two specific roles were identified as being measurably impacted by automation.

• Runners: Previously, QSD required four runners to summon, prep, and escort every patient from the waiting room to their assigned exam room, as well as clean and turn over rooms between patients. With the implementation of CHIME, QSD reduced this role to two runners. This is because the step of summoning and escorting most patients from the waiting room to the assigned exam room was automated and two runners were now sufficient.
• Receptionists: Previously, QSD required multiple receptionists at the front desk windows to check in every patient, including asking standard questions of every patient, as well as other ordinary receptionist tasks. The exact number on duty would vary over the course of each day, based on how busy it was. With the implementation of CHIME, QSD reduced this role by approximately two full-time equivalents. This is because most patients could now check in via a kiosk.

QSD reports that in combination, these four eliminated positions cost the organization at least $160,000 per year, or an average of $40,000 per position. In comparison, QSD’s annualized cost of CHIME is roughly $30,000 per year, resulting in a 500+ percent annual return on investment. That is, for every $1 invested, the organization recouped at least $5. Notably, QSD elected to re-invest at least $80,000 of this annual $160,000 in savings by increasing the staffing in other areas of the organization. QSD therefore achieved net $80,000 in annual savings while simultaneously increasing staffing in some areas.

Increasing Capacity: Anecdotal evidence suggests the potential for increased capacity is there. For example, one high-volume physician was previously allocated three to four rooms whenever he was seeing patients. With CHIME, only two rooms needed to be allocated to him, creating potential room capacity for adding additional clinicians into the clinic. This observation is consistent with an anticipated long-term benefit of the technology, namely, increasing the capacity of the clinic by 40-60 percent, without any renovations or expansion.

The primary author of this case study is Tess Walker, an experienced primary care leader with day-to-day as well as strategic experience in her role as Director of Operations of Magenta Health, a network of primary care clinics in Toronto.