Clinics find value with CHIME orchestrating patient flow

Operating a large primary care clinic with dozens of doctors, allied health staff, medical office assistants and patients coming and going can be both chaotic and expensive. Stressed out front desk staff are busy answering the phones, registering patients and escorting them to exam rooms. Patients are lined up. Tempers flare. However, at clinics employing the CHIME clinical orchestration platform, developed by Toronto-based co-founders Keith Chung and Dan Sobolev, people come and go like clockwork and an atmosphere of calm prevails.Bloorkids, a large pediatric clinic in Toronto with 26 general pediatricians and specialists, seven allied health professionals, five admins, four full-time nurses, 23 exam rooms and 25,000 registered patients, deployed the CHIME orchestration platform in 2021 to maximize the use of the clinic’s space, control costs and optimize efficiency.When patients show up for their appointment, they register on one of two kiosks, take a seat in the waiting room and monitor a display on the wall that informs them of their wait time and tells them which exam room to go to. The kiosks support up to three languages and allow patients to indicate a need to speak with an admin assistant, but 95% of patients have no interaction at all with front desk staff, noted Dr. Dustin Jacobson. In some clinics, there are no admin assistants at all in the front office. They’re only summoned when a request is made using the kiosk. Tablets outside each exam room enable clinicians to check-in and out of appointments, assign tasks to other staff and indicate if the room is ready for another appointment or needs to be cleaned. A central dashboard at reception provides a bird’s eye view of all scheduled appointments and the status of every patient, exam room and clinician, while staff mobile devices, including personal smartphones are used by clinicians to communicate with each other.“If I want a nurse to do vitals on a patient, or if I want a nurse to do a catheter, I can request that on the CHIME devices without having to track down a nurse and physically tell her what I want her to do,” said Dr. Jacobson.The CHIME platform at Bloorkids accesses appointment bookings from the clinic’s Juno EMR through an API integration that automatically synchs booking data in real-time. Juno, said Dr. Jacobson, was selected precisely for its integration capabilities. CHIME also supports API integrations with Telus Practice Solutions, Telus Med Access, Oscar Pro, Accuro and Telus CHR, with the latter two more costly to integrate and requiring more legwork.The bookings retrieved from online bookings in the clinic’s EMR also identify the appointment type, so CHIME knows, for example, if a nurse needs to see a patient prior to a physician consult.“We don’t just move patients into rooms,” explained Sobolev of CHIME Technology. “We manage the entire appointment workflow. Every appointment we import from the EMR is broken down into a series of steps. Some appointments have simple workflows with one or two steps.” Well baby appointments and diabetes management appointments can have much more complex workflows, requiring consults with lactation consultants, nurses or dieticians before or after seeing a physician.CHIME was conceived in 2013 at a Hacking Health event in Toronto that brought together healthcare professionals, designers and developers to brainstorm digital solutions for front line medical challenges. Chung, who was about to open his first of three Magenta Health clinics, “knew that real estate and staffing costs were going to be major drivers of his costs and wanted a solution to help deal with that,” recalled Sobolev. Unable to find anything on the market that was both affordable and scaled for a primary care clinic as opposed to a hospital, he pitched his idea and worked with Sobolev to deploy the first iteration of CHIME in 2015 at Magenta Health.Today, CHIME Technology boasts deployments in 50 primary care clinics and family health teams, including pediatric and dermatology clinics. Most of the company’s clients are in Ontario, and deployed post COVID-19, but there have also been deployments in B.C., Alberta and Manitoba.Clinics range in size from two or three physicians with five exam rooms to very large clinics with dozens of clinicians and as many as 40 rooms. “The more moving parts in a clinic, the greater the value proposition,” acknowledged Sobolev.At Bloorkids, most of the rooms are used exclusively for patient consults and don’t double as physician offices. For charting and virtual appointments, general pediatricians use one of two rooms, each with five or six workstations. “Individual physician offices require so much space,” said Dr. Jacobson. “It’s hard to run a business with that model, but CHIME is not prescriptive about the physical layout of a clinic and leaves that up to clinic management.”CHIME boosts Bloorkids’ bottom line by requiring fewer medical office assistants and increasing the number of doctors that clinic space can accommodate. “If it was cost neutral, it would be a good idea,” said Dr. Jacobson, “but it’s definitely cost beneficial. It allows us to be very efficient and our doctors love it.”Bloorkids is in the process of opening a second clinic in Toronto with 29 exam rooms that will also deploy the CHIME platform.

Clinics find value with CHIME orchestrating patient flow

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