Technical Level: Medium
By default, Clockwise.MD will calculate the patients' visit times based on 'velocity', i.e., the number of patients seen per hour. But there may be times when the clinic wishes to override these calculated values and have the schedule adhere to some different schema.
This can be accomplished via Clockwise's Online Overrides feature. In this article, we'll discuss how to configure the Online Overrides, what is affected by the overrides (and what is not), and when best to use the overrides to meet your clinic's goals.
The overrides configuration page can be found at the traditional Clockwise settings page (https://www.clockwisemd.com/hospitals/xxx/clockwise/settings) and is located under the About This Site > Providers at this facility subgroup. By linking the overrides to individual providers or queues, it is possible to configure the overrides independently of one another, offering the flexibility to match your provider's schedule as closely as possible. Expand the > Providers at this facility grouping, and click the Edit button for the provider or queue on which you wish to apply the override (NOTE: if you're new to Clockwise administration, the terms 'provider' and 'queue' are sometimes used interchangeably depending on whether a clinic wishes to distinguish between types of care offered or between individual providers. While we will make every effort to include both terms when used, it may prove helpful for you to know that if we say 'provider', we may mean 'queue'... and vice versa.)
Once you have drilled into the provider/queue, find and expand the Override Online Times feature.
You will note that the override online times has two options: the ability to show the applied overrides to online patients as well as the ability to show the applied overrides to staff. Click on the button(s) that represent the offerings you wish to present. Unless you have dedicated staff for each provider/queue, it is often helpful to present the same available times to both patients and staff.
Once you have enabled the option(s), you will see the button(s) turn green and a blue 'Configure Slots' button will now appear to the right of the patient/staff buttons. Click the Configure Slots button to begin setup of the overrides.
You will notice the first time you open overrides that there are no values for the Times Between Visits and therefore, no visit times are checked.
Setting the Intervals
Figuring out which interval (aka time between visits) to use is one of the keys to having overrides work successfully. But before we go any further, let's take a moment and see which criteria Clockwise uses in calculating the visit times, and which of these has priority or 'trumps' any of the other criteria.
At the heart of the visit times calculation is 'velocity', i.e., how many patients can your clinic see per hour with a single provider. Barring any other criteria, this is how Clockwise will 'slot' or gap your visit times. A velocity of '4' would be 'four patients per hour', and would result in times being offered 15 minutes apart. A velocity of '5' would yield twelve-minute visits, a velocity of '6' would yield ten-minute visits, and so on.
Closely associated to the default velocity is what we call the 'empty exam room velocity'. Basically, empty exam room velocity says, 'See patients at the default velocity... unless I have empty exam rooms - then see patients at 'this' rate-per-hour. This is sometimes used by clinics as they begin their day to fill the exam rooms as quickly as possible, but has the potential drawback of rooming patients faster than a provider can see them, thus creating an early bottleneck and leading to patient disappointment if an expectation is created which cannot be realistically met.
When you create online overrides, you're telling Clockwise to ignore the visit times calculated through default or empty exam room velocities, and to instead offer visit times based on the intervals you will create in the override section of settings.
Here is a diagram showing which Clockwise criteria take priority ('trumps') any of the other criteria. The criteria at the top of the diagram will take priority over anything/everything found beneath, e.g., empty exam room velocity will always take priority over default velocity.
You will want to carefully consider the following when deciding which intervals to use:
a) for what type of visits will I be seeing patients, and how do they differ in length?
b) how concerned am I about utilizing all of the time between visits?
Let's address the type and length of visits to be offered: if you know that a new patient visit typically takes 30 minutes, but an existing patient visit only takes ten, you might consider offering your visit times based on either a five- or ten-minute interval. Having visit lengths be 'multiples' of each other allows each to nicely fit in the time slots offered.
Also, offering smaller intervals allows you to utilize the maximum amount of minutes and not lose time to a 'leak'. Let's consider an extreme example first, and then make more realistic application to normal visit scenarios. Let's assume that each of your clinic visits take 30 minutes, regardless of acuity or complexity. We know this isn't realistic - we're just using it for illustration purposes. Now let's assume that you set your online override intervals to fall 'on the thirties', i.e., 10:00, 10:30, 11:00, etc. What now happens if your potential online patient goes online at 10:01 to create a visit? He/she only sees the next available slot as being 10:30 so you have potentially 'leaked' or lost 29 minutes because your interval was set so high. If, however, you had created your intervals at a lower multiple, say, five minutes apart, your patient would (at 10:01) now see the next available time as 10:05, allowing the patient to select this time and avoid potentially losing the 29 minutes until the next available time.
Let's see how online overrides screen could be configured to show the five-minute intervals outlined above.
1) First, type the number '5' into the Time Between Visits dialog for any day which your clinic wishes to use overrides, then click Update. Once the page has updated, you'll now see the day represented by five-minute intervals. NOTE: you need NOT check every interval! Some clinics elect to uncheck some of the times immediately after the clinic opens to carve out times to see walk-in patients who may have been waiting at the door at opening. The same may be true for closing, i.e., you may have made a commitment to see any patient who makes it into the clinic before closing - but you do not want to offer online visit times in the last 30 or 60 minutes of the day, again, to preserve those times for your walk-in patients. Lastly, you may wish to block off a section of time during the middle of the day to thin out visits so staff can grab lunch. Just know that for each box you check, a visit time will be offered; for each box you uncheck, that visit time will NOT be offered.
You may also find that, given a large number of boxes to check, it is easier to click the Select All box, then DE-SELECT the boxes you do NOT wish to advertise as available visit times. Use whichever is easiest/fastest for you.
Here is the beginning section of a page whereby the clinic has elected to use online overrides Monday through Thursday, has configured overrides to offer the visit times five minutes apart, and has elected not to offer any times for the first hour (assuming the clinic opens at 8:00 AM).
Keep in mind that OFFERING visits five minutes apart does not necessarily mean that your provider(s) will SEE patients five minutes apart. There are two other criteria which can factor into your visit calculations: visit length and internal blocking. Those criteria will be discussed in the next section. Offering visits at smaller intervals just ensures that your patients have the maximum flexibility in scheduling, and that you are not losing opportunities should the patient visit your page seconds after one available time passes.
Lastly, and perhaps most importantly, be sure that after any/all changes, you click the green Submit Selected Times button upper-right to preserve your changes. All your hard work configuring the overrides will be for naught should you forget to click this button.
Using Visit Lengths and Blocking to Manage Online Visits
Your clinic may know the length of time that is usually associated with certain types of visits, e.g., five minutes for a flu shot, or 30 minutes for a pre-employment physical. If you do know the length of certain visit types, you can assign these 'reasons' a static length and have Clockwise honor that length in its scheduling. You can read more about the configuration and use of reasons at the following knowledge base article:
Configuring ClockwiseMD to Use Multi-Queue (http://clockwisemd.desk.com/customer/portal/articles/2235831-configuring-clockwise-md-to-use-multi-queue)
Without delving too deeply into reasons, overrides allow you to OFFER visit times five minutes apart, even if the known length of the visit is, perhaps, 30 minutes. Once the patient chooses a visit time for the 30-minute visit, Clockwise removes the number of visits which are encompassed by the visit length and then no longer advertises those visit times to the next patient. Again, this allows the clinic to offer the maximum flexibility AND to not lose opportunities if the patient visits the registration a few minutes after the last advertised time has passed.
The second limiter of online overrides is internal blocking. Blocking allows a clinic to determine the ratio between online visit times and walk-in visit times, and to balance that ratio by disallowing additional online visits for a certain number of visit slots. This may be a concern in the early implementation stages of Clockwise in which clinics may be concerned that online volume might exceed walk-in traffic and walk-in patients might face long waits with empty wait rooms. By blocking a certain number of visit slots from online visits, the clinic can more closely maintain the desired ratio of online-to-walk-in visits.
In the following example, let's assume that the clinic is using a velocity of 4.0, i.e., four patients per hour or fifteen minutes apart. If the internal blocking configuration is configured to '1' and an online patient selects a visit time of 10:00 AM, the 10:15 visit slot is not shown to online patients and the next available online time becomes 10:30 AM. If the same scenario is configured to '2', and the first online visit is reserved for 10:00 AM, then the next available online visit is 10:45. The configured number always represents the number of blocked visit slots between the scheduled online visits.
The same, however, is not true for walk-in visits. If the blocking is configured to '1' and the first online visit is at 10:00, and if no one schedules online at 10:30 but that slot is instead taken by a walk-in patient, then the next online available slot would not be until 10:45. Once the online patient schedules the 10:45 slot, the blocking resumes and the next available online slot becomes 11:15 AM. The only setting which would allow back-to-back online visits would be to have the blocking configured to '0'.
You can learn more about online blocking at the following knowledge base article:
• Configuring Online Restrictions
Should you have any questions regarding this article, feel free to contact the Clockwise Support team at any of the channels shown in the right sidebar.