Comprehensive Cost/Benefit Analysis and IoT Recommendations for Reducing Patient Wait Time at eHA Clinics

1. Introduction

Efficient patient flow management is crucial for delivering high-quality healthcare services. For eHA Clinics, a network of Primary Health Care (PHC) facilities in Nigeria, minimizing patient wait times enhances patient satisfaction, optimizes resource utilization, and ensures timely medical interventions. Implementing Internet of Things (IoT) technologies—specifically LoRaWAN devices, LoRaWAN Gateways, Bluetooth Low Energy (BLE) devices, NB-IoT for backhaul and devices, and mobile LoRaWAN devices—can significantly improve the monitoring and management of patient wait times. This analysis explores cost-effective and viable IoT solutions tailored to the Nigerian context, focusing on achieving key performance indicators (KPIs) and adhering to renowned healthcare quality benchmarks such as those set by the Joint Commission International (JCI) and Health Effectiveness Data and Information Set (HEDIS).

2. Use Case Overview: Time Use Patterns – Patient Wait Time

Objective:

  • Patient Wait Time: Reduce the average wait time for initial assessment to meet or exceed the benchmark of 10 minutes.

Key Performance Indicators (KPIs):

  1. Average wait time for initial assessment measured against benchmark (10 minutes).

Benchmarks:

  • JCI Standards:
    • Chapter - Access to Care and Continuity of Care, Standard - ACC 1.1

Current QA/QC Process:

  • Data Collection: The Electronic Medical Record (EMR) system records the time a patient spends in each step of the care process. Care providers manually transition patients through the system, and the informatics team reviews this data against benchmarks.
  • Root Cause Analysis: When benchmarks are not met, root cause analysis is conducted to identify gaps and implement solutions.
  • Team Objectives: Individual teams have Objectives and Key Results (OKRs) focused on achieving benchmarks.

Challenges:

  • Manual Dependence: Reliance on staff remembering to transition patients leads to incomplete or inaccurate data.
  • Data Inaccuracies: Human error and missed transitions result in unreliable data, hindering effective decision-making.
  • Delayed Interventions: Inconsistent data collection delays the identification and resolution of bottlenecks.
  • Resource Constraints: Limited technological infrastructure and budget constraints typical in low-income settings impede the adoption of automated solutions.

Desired Outcome:

  • Automated Monitoring: Real-time tracking of patient movements through the care process.
  • Enhanced Data Accuracy: Reliable and up-to-date data collection with minimal manual intervention.
  • Proactive Management: Timely alerts and automated responses to reduce wait times and improve patient flow.
  • Improved Compliance: Adherence to JCI standards through efficient patient flow management.

3. Proposed IoT Solutions

A. LoRaWAN-Based Patient Flow Management System

  1. LoRaWAN-Enabled RFID Tags:
    • Usage: Attach RFID tags to patient wristbands to track their movement through different stages of care.
    • Function: Automatically record the time a patient enters and exits each stage, transmitting data to LoRaWAN Gateways.
    • Recommended Products:
      • Impinj Speedway Revolution R420: A reliable RFID reader compatible with LoRaWAN for accurate patient tracking.
      • Alien Technology ALR-F800: Cost-effective RFID tags suitable for healthcare environments.
  2. LoRaWAN Gateways:
    • Usage: Install gateways at strategic points within PHC facilities to collect data from RFID tags.
    • Function: Ensure reliable data transmission to the central management system via NB-IoT.
    • Recommended Products:
      • The Things Gateway (TTN): Affordable and supports open LoRaWAN protocols, ideal for PHC coverage.
      • Kerlink Wirnet iStation: Durable and reliable, suitable for various environments with non-proprietary connectivity.
  3. NB-IoT Integration:
    • Usage: Utilize NB-IoT for robust, low-power communication between RFID tags and the central system.
    • Function: Ensure seamless data flow even in areas with limited connectivity, crucial for rural PHCs.
    • Recommended Products:
      • SIMCom SIM7000A: Affordable and reliable NB-IoT module suitable for integration.
      • Quectel BC95: Known for reliability and low power consumption, ideal for IoT applications in resource-constrained environments.
  4. Mobile LoRaWAN Devices for Staff:
    • Usage: Equip staff with mobile devices to receive real-time alerts and access patient flow data.
    • Function: Enable timely interventions to address bottlenecks and optimize patient flow.
    • Recommended Products:
      • Kerlink Wirnet iFemtoCell: Portable and compact, ideal for mobile healthcare providers.
      • Multitech Conduit M: Versatile gateway supporting multiple IoT protocols, including LoRaWAN.

B. Data Analytics and Dashboard Integration

  1. Centralized Odoo Integration:
    • Usage: Integrate IoT data with the existing Odoo-based EMR system.
    • Function: Provide a unified platform for data analysis, trend monitoring, and decision-making.
    • Recommended Solutions:
      • Odoo IoT Box: Connects IoT devices directly with Odoo, enabling seamless data flow.
      • Custom Odoo Addons: Develop or utilize existing addons to capture and display patient flow data within the EMR system.
  2. Audiovisual Alerts:
    • Usage: Implement audiovisual alerts on Odoo dashboards for critical KPI deviations.
    • Function: Prompt immediate action from healthcare providers to address potential delays in patient flow.
    • Recommended Products:
      • Grafana: Open-source platform for creating interactive dashboards with alerting features, which can be integrated with Odoo.
      • Kibana: Part of the Elastic Stack, suitable for real-time alerting and visualization without proprietary restrictions.

C. Patient Engagement Tools

  1. Mobile Applications:
    • Usage: Develop patient-facing apps to provide real-time updates on wait times and appointment statuses.
    • Function: Enhance patient satisfaction by keeping them informed and engaged during their visit.
    • Recommended Products:
      • mHealth Nigeria: A locally developed app tailored for Nigerian patients to manage appointments and receive real-time updates.
      • CommCare: An open-source platform for building mobile applications customized to patient needs, offering flexibility and cost-efficiency.
  2. Automated Reminder Systems:
    • Usage: Schedule automated reminders for upcoming appointments and estimated wait times.
    • Function: Reduce no-shows and improve overall appointment adherence.
    • Recommended Products:
      • Twilio: For building automated SMS and call reminder systems using standard IoT communications.
      • Africa's Talking: A locally focused communication platform suitable for SMS and voice services in Nigeria, reducing costs associated with international services.

D. Complementary Connected Diagnostics (Home and Mobile Use)

  1. Connected Patient Call Bells:
    • Usage: Install smart patient call bells in strategic locations to enhance patient safety and timely response.
    • Function: Ensure patients can easily request assistance, reducing wait times and improving overall experience.
    • Recommended Products:
      • Sado S501 Smart Call Bell: BLE-enabled call bell compatible with LoRaWAN for seamless integration.
      • Loop Healthcare Call Bell: Open-source compatible with LoRaWAN, ensuring flexibility and cost-effectiveness.
  2. Connected Wearable Devices:
    • Usage: Provide patients with wearable devices that monitor vital signs and track their movement within the clinic.
    • Function: Enable continuous monitoring of patient status, triggering alerts if wait times exceed benchmarks.
    • Recommended Products:
      • Fitbit Charge 5: Offers vital sign monitoring and can be integrated with IoT systems for real-time data transmission.
      • Garmin Vivosmart 4: Provides comprehensive health tracking and is compatible with BLE for data transmission.

4. Cost/Benefit Analysis

A. Costs

  1. Initial Investment:
    • LoRaWAN-Enabled RFID Tags:
      • Impinj Speedway Revolution R420: ~$700 per reader; estimated 5 gateways = $3,500
      • Alien Technology ALR-F800: ~$50 per RFID tag; estimated 1,000 tags = $50,000
    • LoRaWAN Gateways:
      • The Things Gateway (TTN): ~$150 per gateway; estimated 20 gateways across PHCs = $3,000
      • Kerlink Wirnet iStation: ~$1,200 per gateway; alternative option = $24,000
    • Mobile LoRaWAN Devices for Staff:
      • Kerlink Wirnet iFemtoCell: ~$300 per device; estimated 50 devices = $15,000
      • Multitech Conduit M: ~$250 per device; alternative option = $12,500
    • NB-IoT Infrastructure:
      • SIMCom SIM7000A Modules: ~$20 per module; integrated into devices.
      • Quectel BC95: ~$15 per module; alternative option = $7,500
      • Comprehensive Setup (e.g., Quectel BC95): ~$10,000
    • Data Analytics and Dashboard Integration:
      • Grafana Implementation: Open-source, implementation costs ~$10,000
      • Odoo IoT Integration: ~$15,000
    • Patient Engagement Tools:
      • mHealth Nigeria Development: ~$20,000
      • CommCare Customization: ~$15,000
    • Complementary Connected Diagnostics:
      • Fitbit Charge 5: ~$150 per device; estimated 500 devices = $75,000
      • Sado S501 Smart Call Bell: ~$50 per device; estimated 200 devices = $10,000
    • Total Initial Cost: Approximately $205,500 (using mid-range estimates and lower-cost alternatives where applicable)
  2. Operational Costs:
    • Maintenance and Support: ~$10,000 annually
    • Data Management and Storage: ~$15,000 annually
    • Subscription Fees for IoT Services: ~$15,000 annually (including Twilio and Africa's Talking)
    • Device Replacement and Upgrades: ~$25,000 annually
    • Total Annual Operational Cost: Approximately $65,000

B. Benefits

  1. Improved Health Outcomes:
    • Reduced Complications: Timely assessments and interventions prevent complications in hypertensive and diabetic patients.
    • Enhanced Illness Control: Continuous monitoring ensures better blood pressure and blood glucose control, reducing the risk of severe health issues.
  2. Operational Efficiency:
    • Automated Monitoring: Reduces manual data entry errors and ensures consistent tracking of patient flow.
    • Proactive Management: Real-time data enables timely adjustments in patient flow, minimizing wait times and optimizing resource utilization.
  3. Compliance and Accreditation:
    • JCI and HEDIS Standards: Automated systems facilitate adherence to ACC 1.1 and effectiveness of care benchmarks, supporting accreditation efforts and enhancing facility reputation.
  4. Cost Savings:
    • Efficiency Gains: Streamlined operations reduce the need for additional staffing and minimize downtime, leading to cost savings.
    • Preventative Care: Early detection and management of health issues reduce the need for costly emergency interventions and hospitalizations.
  5. Revenue Enhancement:
    • Increased Patient Volume: Improved patient satisfaction and reduced wait times attract more patients, increasing revenue.
    • Enhanced Reputation: Compliance with international standards boosts the clinic’s reputation, attracting partnerships and funding opportunities.
  6. Enhanced Data Accuracy:
    • Reliable Data Collection: Accurate, real-time data supports better decision-making and resource allocation, ensuring optimal facility conditions.
    • Comprehensive Reporting: Facilitates detailed reporting for audits and compliance checks, enhancing transparency and accountability.
  7. Patient and Staff Satisfaction:
    • Enhanced Patient Experience: Reduced wait times and transparent processes improve patient satisfaction and loyalty.
    • Reduced Administrative Burden: Automation frees up staff to focus more on patient care and less on manual tracking and data entry.

C. Return on Investment (ROI)

  • Cost Savings and Revenue Enhancement:
    • Preventative Care and Efficiency Gains: Significant reduction in costs associated with managing patient flow inefficiencies and preventing complications.
    • Increased Patient Volume and Trust: Higher patient retention and acquisition rates contribute to revenue growth.
  • Estimated ROI Timeline:
    • Initial Investment Recovery: Approximately 3 years through cost savings from operational efficiencies, reduced complications, and increased revenue from enhanced patient satisfaction.
    • Long-Term Benefits: Continued operational savings and sustained revenue growth contribute to long-term financial and quality improvements beyond the ROI timeline.

5. Impact on Health Care Quality Benchmarks

A. JCI Standards Compliance:

  1. ACC 1.1 (Access to Care and Continuity of Care):
    • Enhanced Continuity: Automated patient flow tracking ensures ongoing management of patient movements, reducing gaps in care access.
    • Timely Interventions: Automated alerts facilitate swift actions to address delays in patient flow, maintaining consistent care standards.
  2. Data-Driven Quality Improvement:
    • Reliable Data Collection: Accurate, real-time data supports comprehensive quality assurance and continuous improvement initiatives.
    • Root Cause Analysis: Enhanced data fidelity aids in identifying and addressing underlying issues affecting patient wait times and overall care quality.

B. HEDIS Standards Compliance:

  1. Effectiveness of Care - Cardiovascular Conditions:
    • Blood Pressure Control: Automated monitoring ensures patients maintain medication regimens and achieve blood pressure targets, aligning with HEDIS effectiveness criteria.
  2. Effectiveness of Care - Diabetes:
    • Glycated Hemoglobin Control: Continuous monitoring and timely interventions help patients achieve and sustain HbA1c targets, meeting HEDIS standards.

C. Additional Quality Benchmarks:

  1. Patient-Centeredness:
    • Transparent Processes: Real-time updates and reduced wait times ensure patients receive timely and efficient care, fostering a patient-centered approach.
  2. Efficiency:
    • Optimized Workflows: Automation reduces administrative burdens related to manual tracking, allowing healthcare providers to focus more on patient care.
  3. Safety:
    • Error Reduction: Automated data collection minimizes human errors, enhancing patient safety and data integrity.

6. Best Wins and Recommendations

A. Best Wins:

  1. Automated Patient Flow Tracking:
    • LoRaWAN-enabled RFID tags ensure continuous monitoring of patient movements, reducing the risk of missed transitions and enhancing data accuracy.
  2. Proactive Wait Time Management:
    • Automated alerts for extended wait times enable timely interventions, ensuring adherence to the 10-minute benchmark and improving patient satisfaction.
  3. Real-Time Data Integration:
    • Seamless integration with Odoo’s EMR system provides comprehensive visibility into patient flow, facilitating informed decision-making and proactive management.
  4. Enhanced Operational Efficiency:
    • Automation reduces the time and effort required for manual tracking and follow-up, allowing staff to focus more on critical patient care tasks.
  5. Connected Diagnostics for Home Use:
    • Devices like connected blood pressure monitors and glucometers enable continuous monitoring from home, ensuring comprehensive care and reducing the burden on PHC facilities.

B. Recommendations:

  1. Pilot Implementation:
    • Scope: Launch a pilot program in a select number of PHC facilities to evaluate system effectiveness and identify potential challenges.
    • Objectives: Assess data accuracy, system reliability, user adoption, and impact on KPIs.
  2. Comprehensive Staff Training:
    • Training Programs: Conduct training sessions for healthcare providers on using IoT devices, interpreting data, and responding to alerts.
    • Ongoing Support: Provide continuous technical support to ensure smooth operation and address any issues promptly.
  3. Scalability and Flexibility:
    • Infrastructure Planning: Design the IoT system to accommodate scaling across all PHC facilities, considering varying patient volumes and infrastructure capabilities.
    • Modular Implementation: Implement IoT components in phases, allowing for flexibility and adjustments based on pilot feedback.
  4. Data Security and Privacy:
    • Compliance: Ensure all IoT solutions comply with data protection regulations and maintain patient confidentiality.
    • Security Measures: Implement robust security protocols to safeguard data from breaches and unauthorized access.
  5. Continuous Monitoring and Optimization:
    • Performance Metrics: Regularly evaluate system performance against KPIs and make necessary adjustments to enhance effectiveness.
    • Feedback Loops: Collect feedback from both patients and healthcare providers to identify areas for improvement and ensure the system meets user needs.
  6. Expand IoT Applications:
    • Additional Use Cases: Once patient wait time management is optimized, explore extending IoT solutions to other areas such as inventory management, environmental monitoring, and equipment tracking to further enhance operational efficiency and patient care quality.
  7. Leverage Connected Diagnostics for Enhanced Care:
    • Home Diagnostics: Encourage the use of connected diagnostic devices for continuous monitoring, integrating data seamlessly into the Odoo EMR system.
    • Telehealth Integration: Combine IoT data with telehealth services to provide comprehensive virtual consultations based on real-time patient data.

7. Marketing and ROI Messaging

  • Optimize Patient Flow, Enhance Care Quality: With eHA Clinics' advanced IoT-based patient flow management solutions, your facilities ensure patients receive timely and efficient care, boosting satisfaction and trust.
  • Cost-Effective Healthcare Innovation: Invest in IoT technologies that deliver significant cost savings through automated monitoring and proactive management, reducing the financial burden of inefficiencies.
  • Achieve and Exceed Quality Standards: Seamlessly comply with JCI and HEDIS standards, positioning eHA Clinics as a leader in quality healthcare delivery in Nigeria.
  • Enhance Operational Efficiency: Streamline your patient flow operations, allowing your staff to focus more on patient care and less on administrative tasks.
  • Scalable Solutions for Sustainable Growth: Our IoT infrastructure is designed to grow with your organization, ensuring long-term sustainability and continuous improvement in patient care.
  • Local Solutions for Local Needs: Our recommended products and systems are tailored to the Nigerian context, ensuring affordability, reliability, and ease of integration within existing infrastructure.
  • Innovative Integration with Odoo: Leverage Odoo’s robust ecosystem, including Field Service, FSM, and Maintenance addons, enhanced with IoT data integration for comprehensive patient and facility management.
  • Future-Ready with HomeAssistant Integration: Explore the potential of integrating a commercial-use variant of HomeAssistant to act as a building management system, further enhancing automation and control where it makes sense.

8. Conclusion

Integrating LoRaWAN, BLE devices, NB-IoT, and mobile LoRaWAN technologies for managing patient wait times presents a strategic and financially viable opportunity for eHA Clinics to enhance patient flow management across its PHC facilities. The proposed IoT-based system offers substantial benefits, including improved data accuracy, operational efficiency, compliance with JCI and HEDIS standards, and increased patient and staff satisfaction. With an initial investment of approximately $205,500 and manageable annual operational costs, the long-term cost savings and revenue enhancements, coupled with the positive impact on quality benchmarks, make this a compelling initiative.

Prioritizing automation in this use case aligns with eHA Clinics' commitment to delivering high-quality, patient-centered care and positions the organization as a leader in leveraging technology for healthcare excellence in Nigeria. By incorporating connected diagnostics for home use and ensuring seamless integration with the existing Odoo EMR system, eHA Clinics can provide continuous, comprehensive care that extends beyond the clinic setting, thereby significantly enhancing the overall healthcare ecosystem.

Given the medium automation priority for patient wait time management, eHA Clinics should focus on implementing high-impact components that offer the highest ROI and scalability first. Pilot programs can help demonstrate effectiveness, secure additional funding, and build the necessary infrastructure and expertise for broader deployment.

Investing in IoT solutions for managing patient wait times not only fulfills compliance requirements but also fosters a culture of efficiency and proactive healthcare, ultimately leading to a more satisfied patient population and a more effective healthcare delivery system.