RFID technology-enabled Markov reward process for sequencing care coordination in ambulatory care: A case study

Care coordination is vital for patient-centered care delivery. While communication is key to sharing information, sequencing the critical activities associated with care delivery is key to process efficiency and safety. The “communication” aspect has been often addressed by computer systems, but very limited attention has been paid to the “sequencing” aspect. Alongside, although real-time location systems (RTLS) are widely used for tracking purposes, they have not been used to develop analytical models for decision making, thus advancing the role and value of information technologies (IT). This paper proposes a data driven solution for developing prescriptive policies regarding the sequencing of care delivery activities in ambulatory care such that the goal of well-coordinated care may be achieved. Specifically, we propose a Markov Reward Process model to find the optimal care delivery sequence that minimizes patient waiting time using empirical data collected by Gen2IR/RFID technology in an outpatient clinic. We demonstrate improved sequencing of care delivery activities in comparison to status quo. The application of RFID in this study elevates the value of RTLS in healthcare from just tracking and identifying objects/persons to guiding and changing operational activities. Our method is generalizable to a variety of care coordination problems in different care delivery settings, and can be embedded in decision support systems for better operational sequencing of care delivery activities.