A Short History of Patient Scheduling Tools in Dialysis – Part 2

We left off having completed the B.C. mini-epoch, Before Computers. In this installment, we are going to revisit the timeline of patient scheduling tools and talk through the A.C. mini-epoch.

A.C. — After Computers

Once computers were on the scene, innovations came quickly. In 2003 when I began in dialysis, most clinics used either Microsoft Word or Microsoft Excel to manage their schedules. So I have to assume that some folks were inputting their patient schedules into a computer roughly by the mid-1980’s.  Let’s take a look at some of the technologies that people tried to use to help them with their patient schedules.

Word Processors: (evolution of word processors)
Word processor… now there’s an ancient term in computing! Nowadays, Microsoft Word is the dominant application, but Corel Word Perfect was what I used long ago. And I’m sure some savvy managers in dialysis transcribed their handwritten schedules into a word processor. And it allowed them to save their schedules, easily edit them, track files historically, and more easily share schedules with others. These were huge gains in productivity! But it was the simplest of use-cases for what the computer could really do. These were the baby steps we took… from handwriting schedules on paper to managing schedules on the computer. And we never looked back! Computers were here to stay! By the way, word processors are still in use. I ran across a schedule in MS Word just the other day!

DOS: (history of MS DOS)
A humble little DOS application for patient scheduling made its way on the scene. The only reason I know about this is because it was created by my first boss and mentor at DaVita, Doug Vlchek (Yoda). I never got to see it in action, just manuals of it. But I loved it! To my knowledge, it was the first “program” built for managing patient schedules at dialysis facilities. 

[INSERT YOUR COMPUTER APPLICATIONS HERE! As I have mentioned before, this timeline is based on my experiences within the dialysis industry. This history can only be complete with your input! If you know of any early applications that effectively predate the dominance of spreadsheets, please let me know and I will put in a blurb about it here! Anything that is 2005 or later would be considered internet-age, and so I plan to include those in a later installment.]

SPREADSHEETS: (history) (history) (history) (history)
Since this topic is near and dear to my heart, I have included several history links for those of you who care to indulge. =]

Not everyone knows this, but the now ubiquitous spreadsheet also has its roots in paper, specifically a long paper ledger that could be unfolded (spread) providing many columns for information management. There have been many incarnations of spreadsheet applications over the years: Visicalc was the first, Lotus 1-2-3 and Quattro Pro (both of which I used in my time) came later. But Excel is probably the most familiar spreadsheet application to everyone.

Dan Bricklin @ 11’17” Harvard commemorates the location of the invention of the first spreadsheet.

When I came to DaVita in 2003, most clinics were already using Excel. So I’d say that it is safe to assume that spreadsheets became the most ubiquitous patient scheduling tool around the mid-to-late-1990’s. But unfortunately these tools were using Excel as little more than graph paper to display the schedule within pretty boxes. And there were TONS of styles and colors. Remember when everyone used Comic Sans for everything!

But the power of using a spreadsheet is in using formulas to do the calculations work for you, like calculating the take-off time based on the put-on time plus the duration. Surprisingly, most people didn’t use Excel to do even this much. And for things like conditional formatting which could help you identify problem spots in the schedule… fuggedaboutit!

Most of the spreadsheets that I have encountered in my dialysis career do not utilize the spreadsheet in any way to help the administrators manage their schedule. They didn’t then and they still don’t now. It’s really puzzling to me, other than to say that it is not a clinician’s first inclination to learn how to use spreadsheets effectively.

Luckily, people with Excel skills came along and began to develop models to help with patient scheduling, and some of these models could get quite advanced, turning the patient schedule spreadsheet into a sophisticated little application.

Spreadsheets quickly became the de facto standard for scheduling at dialysis clinics. As an industry, we did some innovative things with this tool/application. It helped us to be more productive in managing the scheduling process. And it helped some organizations with standardization of scheduling processes because everyone was using the same tool and following the same rules.

But while we made significant progress, there were some obvious areas that the spreadsheet couldn’t address, such as allowing other users to access your schedule easily, or managing your data over time, and reporting trends in your data. These were the next stages of innovation that would need to be addressed in other ways, with better technology. But there is little doubt, spreadsheets provided us with a better way to manage our patient schedules… and staff schedules, too!

We’re not done with spreadsheets yet, though! In Part 3 of the series, I’ll dive deeper into Excel and some modeling ideas that I either saw or created with Excel. There are a number of these models that I will share, and I encourage you to take a look at them… if only for a walk down memory lane.

See you there!

[CALL TO ACTION! I would really appreciate you sending your own spreadsheet schedule templates to me if you'd be willing. I'll post them as part of this little history we are creating (without real patient info, of course)! It will be a grand tribute to the ideas that helped shape scheduling in this industry over the past five decades.]

A Short History of Patient Scheduling Tools in Dialysis

The dialysis industry is coming up on the 50th anniversary since Medicare extended coverage to individuals with ESRD. In that time, a lot of things have changed. If you’ve been working in dialysis for 20 years or more, then chances are you’ve seen a number of scheduling methods and tools come and go!

While I know this is just a small, non-clinical part of the rich history of dialysis… this is such a fascinating topic in the history of this industry — at least for my experience in it. I figured that it needs to be recorded somewhere, so I thought to take a stab at it. And in this five-part series, I’ll look specifically at the history of dialysis scheduling tools and applications.

What I will attempt to outline in these posts is a simple timeline of dialysis scheduling tools that I have been witness to during my career in dialysis. But this timeline cannot be considered complete without your input. I know there are other tools out there, so I hope some of you reading this might share what you know (and even the tools you’ve used! or at least a screenshot) and I will share them here and fit them into the timeline.

In a simplistic attempt to categorize these innovations, I have broken up the history into mini-epochs. Let us call them B.C., A.C., A.E., A.I. Pretty soon, you’ll know what they all mean. Let’s begin!

B.C. — Before Computers

That’s right! You thought I was getting religious on you. =] B.C., in this timeline, means before computers! Before computers were adopted as being useful in the clinic for managing the schedule, we had a few different ways to help us track and manage schedules.

Can you believe it? It’s almost unthinkable now that someone would have to write out the schedule every day by hand. But still, even as recently as 5 years ago, I have seen handwritten schedules in use. I guess those clinical managers never saw the need to adopt a new tool, tried and true in their own systems they were! They say that old habits die hard, but geez louise!

PHOTOCOPIER: (a tribute to the photocopier)
How did we make copies of our schedules to distribute before the photocopier came of age? Carbon Copy paper was certainly around, but I’m not so certain that it was all that
practical for making copies of patient schedules. But what is certainly unforgettable is the serious contribution of the photocopier! These machines were in use way before desktop computers, and they allowed us to make copy after copy of schedules for staff and nurses stations. Enter in a few changes manually, and you just saved a LOT of time with your schedule!

Interestingly, this is a technology that has not gone out of style either, as they are still very much depended on even today!

While I never witnessed the use of a white board in person, I have been told that schedules were also managed this way in some clinics. It’s not hard to imagine how it was used. One downside with this method, though, you really couldn’t keep a copy of your schedule. So I’m not sure this qualifies as an innovation, so much as for a point in history.

Alright! Now here is a cool concept! Let’s represent our patients with magnets on a board, and when we put them on dialysis, we’ll move their magnet into place so we know who is running and where they sit. And if they had a magnetic whiteboard, they could write all over it, too. When I started dialysis in 2003, this was the scheduling tool in use at one of the first centers I visited.

And I’m not being sarcastic with my “cool concept” accolade. Believe it or not, these sorts of boards are in use at manufacturing facilities the world over. So yes, I do think this is a cool concept to apply to dialysis patient schedules. It actually gave a visual representation of the floor, and a real-time understanding of who was running. It served as a schedule and a real-time operations tool, though I’m guessing it was used in conjunction with a handwritten schedule, or otherwise you’d lose your schedule as soon as you move magnets around the board.

So let’s not discount the humble magnet board as an innovative step toward scheduling patients!

[NOTE: Pictures tell a thousand words. If you readers have any pictures of these relics of patient scheduling, do please share!]

So that was a healthy dose of nostalgia. =] There is a lot to cover in a 50-year timeline, so I’m keeping each part purposefully short.

In Part 2 of this series, we’ll move on to the next mini-epoch, A.C. — After Computers. Once computers were on the scene, innovations came quickly. And we’ll revisit the first part of the A.C. mini-epoch from word processors up through the modern spreadsheet!