The Menu, please!

When you go to a restaurant you don’t go to the back kitchen, go through a filing cabinet to find a recipe for the meal you are looking for, dispatch someone to purchase all of the needed ingredients, and then proceed to cook your own meal.  This is why menus were invented.

A restaurant menu details a range of choices from which you can pick one and then optionally add in certain sub-choices.  The range of choices varies from restaurant to restaurant and across different types of restaurants. Don’t expect to find Mexican menu items in a seafood restaurant.

In respect of Chinese food, here, we quickly get to “super-menus” where you can order “two dinners for three for five” or perhaps you might be better off with “six dinners for one for five” that you would then share with your four guests? Super menus aside, the range of meal options and permutations and combinations at restaurants pales in comparison to open options in the case of the delivery of healthcare services to patients.

Consider a regional clinic/hospital using an EMR where there could be hundreds of “best practice” protocols for individual diseases, with the caveat that what might be classified as a 1st line treatment of choice for one disease could end up being contraindicated because of the presence of one or more other diseases/problems/conditions.

The “best practices” protocol selection problem is best handled, by, can you believe it, a menu?

The logic is pretty straightforward.

1) All work consists of fixed time appointments and “floating time tasks” otherwise known as a “to-do list” (Fixed time appointments plus floating time obligations covers 100 % of all work as we know it).

2) At each patient appointment or at each task relating to a patient, we are either proceeding along a care pathway that is a private instance of a best practice protocol or the nature of the required intervention to be rendered to the patient at this particular moment in time is such that an ad hoc intervention is appropriate. (Structured work plus unstructured work covers 100% of work as we know it).

It follows that the required interface is a single computer screen where you present to the user on one side of the screen a list box (to-do tasks) and a calendar of events on the other side.  With this configuration,  you need only add a button that lets you call a menu of all possible best practice protocols, augmented by a list of interventions of one step each to accommodate ad hoc interventions not covered by best practice protocols.

Add to this an automated resource allocation environment where tasks are assigned to staff on the basis of skill level and availability and you have an enterprise EMR.

All of which brings us to how do we get patients streamed onto best practice protocols and how ad hoc interventions are engaged?  The answer is “a menu”.  If you take a look at, say, the services directory at Cleveland Clinic, it quickly becomes obvious that a hierarchy of menus may be needed to avoid long scrolling menu.

However, picking options can be simplified if the software environment you are using has “daisy chaining” facilities – when one process terminates or is about to terminate the software can post a decision box with suggestions for continuing services on the basis of available data and enterprise policy/procedure.

Menus at user interfaces plus in-line compliance controls at Cases helps to reduce complexity, increase patient throughput, decrease admin/clinical errors, and improve compliance all of which help reaching the twin goals of improving individual patient outcomes and enterprise level outcomes.


Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, connect-the-dots law enforcement investigations, healthcare services delivery, job shop manufacturing and b2b/b2c/b2d transactions. (C) 2010-2018 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
This entry was posted in Automated Resource Allocation, Business Process Management, Compliance Control, Decision Making, FIXING HEALTHCARE, Productivity Improvement. Bookmark the permalink.

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