Opt-Out of Virtual Orchestration
This page summarizes the “No VO” approach to Virtual Orchestration for physicians who would prefer not to use VO at all. It outlines the benefits an drawbacks to this approach, for physicians who see a more limited benefit from VO.
To activate this option, click on your name in the flow view, then select your preferred option from the dropdown. Save details.
Note: it is okay to switch between opting in / out in real time (e.g. for an afternoon).
Opt-out of Virtual Orchestration if Offsite
You can simply ignore VO when you are working offsite.
As outlined below, admin will not be calling or checking that your patients are ready. Your virtual patients will not appear in CHIME when you are working from home.
Opt-out of Virtual Orchestration Always
When you take an in-clinic room to see your virtual patients, select the status “[MD Name] seeing virtual patients” on the room tablet
Your name will be pre-filled in this status - you will just need to select yourself
When you leave the room, check out as you normally would if you were seeing an in-person patient by tapping on the room tablet.
That’s it! You do not need to keep track of your virtual patient queue.
As outlined below, admin will not be calling or checking that your patients are ready. Your virtual patients will not appear in CHIME.
Opt-out - Benefits and Drawbacks in Detail
It’s helpful to first know the key intended benefits of VO for (1) you as an individual, (2) MDs as a group, (3) staff, and (4) patients:
For you personally, one core benefit was supposed to be streamlining your virtual appointments by ensuring your patients are usually ready for you. Reducing no shows, reducing patient angst and conflict, etc.
For MDs as a group, one core benefit is making sure exam rooms aren’t being unnecessarily “blocked”. The status quo is that exam rooms are prioritized for the purpose of MDs having appointments with patients, whether in-person or virtual, with staff empowered to ask MDs to move to a different workstation if they are using an exam room for only paperwork. One benefit of VO for the MD group generally is recovering this lost visibility into what is happening inside a room to prevent exam rooms from being unnecessarily kept out of circulation and resulting in room shortages.
For staff, CHIME is important as it gives both onsite and offsite staff visibility into what is happening inside the clinic. Who is where? What’s the status of every room? If a patient returns a MD call via the clinic backline, where is the MD and what are they doing? Can they be disturbed? If there’s an urgent protocol for a MD, where are they and what are they doing? Having this visibility into what is happening inside the clinic ensures staff don’t need to waste their time running around trying to track someone down or tentatively knocking on a closed door and potentially interrupting sensitive appointments.
For patients, VO was intended to (A) help them remember and attend their appointment and (B) to make them feel less “forgotten” and have a sense of how long they will need to wait.
When conceptualizing a “No VO” approach, we kept the above in mind. In essence, when a physician isn’t using VO, we still want…
PREFERABLY keeps, where possible, any benefits to you personally
MUST keep benefits to your MD colleagues
MUST not burden staff to the detriment of your MD colleagues
PREFERABLY keeps benefits for staff such as reduced cognitive load
PREFERABLY keeps, where possible, any benefits to patients
WORKS in the context of vacation coverage (E.g a non-VO MD covering a VO MD; a VO MD covering a non-VO MD)
OFFSITE, these concerns aren’t much of an issue, so you will be able to fully ignore VO.
ONSITE, the workflow is as follows:
Your virtual patients will not be visible in CHIME to you or staff at all though. You can basically work through them the way you would pre-VO, by just using your schedule within the EMR.
When you enter a room to see virtual patients, instead of simply making it N/A, we’ll add a new status that the room status is “[MD Name] seeing virtual patients.” Each MD who opts out of VO will be individually listed, people will need to choose themselves. When you leave a room, just change the room back to “Room is Ready” / Green on the room tablet like normal.
To help keep some benefits for you and patients, your patients can still check in remotely, but they won’t be texted, they won’t be called, and they won’t see a real-time wait time. The check-in will purely be to help the patient not feel “forgotten”. The system will “pretend” to check-in patients automatically, even if they don’t do so. This is what your patients will see if you are not using VO -
Staff will be trained to only semi-trust the status of rooms that have a status of “[MD Name] seeing virtual patients.” They’ll be explicitly told to cross check the MD’s schedule, and that it’s okay to knock on the door to double check when appropriate. They should try to minimize doing this obviously. Preferably, if you are in a room but no longer seeing virtual patients, go into CHIME and change the status of the room to something more appropriate.
The only ask is that you change the room status to a specific status, as opposed to the more generic “N/A” status.
Moreover, if you’re someone that doesn’t like to “intermingle” onsite and virtual patients, you won’t really have anything to worry about.
If you want to “intermingle” onsite and virtual patients without using VO, the suggestion is to avoid this generally, for the following reasons:
CHIME will be mostly ignoring your virtual patients, and so CHIME won’t be able to find a room for you to see your next virtual patient after seeing an in-person patient. When the clinic is busy, it’s going to be annoying for you.
Your virtual patients won’t show up in CHIME, so you’ll need to remember them on your own. E.g. the fact you have a virtual patient before your next in-person appointment won’t be obvious. Without VO, we’ve had a surprising number of incidents where patients have been forgotten by the MD entirely because they’re focusing on their in-person appointments.
The auto-rooming of in-person appointments will need to be adjusted when you’re in a status of “[MD Name] seeing virtual patients”. CHIME is going to not have any insight into the status of your virtual appointments and doesn’t know how much longer you’re going to be in that state. CHIME will therefore make an estimate of how long you will be in the room based on your number of upcoming virtual appointments and will auto-room the next in-person patient accordingly. If you want the patient to be seen sooner, it will be best to drag and drop them yourself into a room. Staff will probably also keep an eye on things and try to help out, and maybe we can find a way to automate this down the road, but at least initially, not having VO means this will be very complicated to achieve in an automated way.
To summarize:
You can basically stop using VO
Offsite - it’s fine to completely ignore VO
Onsite - if you’re not intermingling in-person and virtual patients, you shouldn’t have any significant issues
We recommend against intermingling because there’s going to be some downsides for you