Using Google Docs to facilitate patient flow in a community health center

Guest post: David Margolius is a medical student at Brown University. He is spending the year in San Francisco as a research fellow and recently began working with Southeast Health Center to improve access, patient care, and clinic flow. He changed patient management at the clinic by using a shared Google Doc to make it easy for staff and providers to communicate in real time, without walkie-talkies, pagers, and interruptions.

Southeast Health Center is a community-oriented primary care clinic in San Francisco. Through Healthy San Francisco, a program created by the City of San Francisco, Southeast and other clinics make health care services accessible and affordable for uninsured residents. The program offers a new way for San Francisco residents who do not have health insurance, to have basic and ongoing medical care.

At Southeast, all of this work can make it difficult to keep track of which patients are in which rooms, how many patients are in the waiting room, and how far the doctors are falling behind with their patients for the day. Up until about a month ago, when patients checked in, the front desk would page the medical assistant who would then escort the patient to a room when one was free. The assistant would then let the doctor know that the patient was available. If patients were late, canceled their appointments, or the waiting room was overflowing, the doctor would be the last to know. All in all, communication was linear, uncoordinated, and difficult.

The medical director asked me try to figure out something better…anything better. After observing clinic flow for a few days, my first thought was to build some sort of intra-office communication device with switches and LED lights. I found an intra-office light communication system online and with the director's permission was ready to spend some big time money on it, but a friend of mine ruined all of my crazy ideas by saying: “Why can’t you just do that in Google Docs?”

A few days later, Southeast Health Center fully incorporated the “Check-in Tracker”, a shared spreadsheet on Google Docs, into their clinic flow which you can see a sample of below:



When a patient checks in at the front desk, the clerk types “a” into the slot where that patient was scheduled. Using the “change color with rules” function, that slot turns orange to let everybody in the clinic know that Dr. Mark’s 8:15 AM patient has arrived. If the 8:55 AM patient arrives at 9:15 AM, the front desk types in “L 9:15” into that slot and the slot turns pink. Dr. Mark can look at the Google spreadsheet and type an “x” if he is unable to see the late patient or “ok” if he has time to see the patient. Patients in rooms turn green and indicate which room number. Discharged patients turn blue.

Everybody communicates in real time, because we are all using the same shared spreadsheet. Medical assistants, doctors, providers, clerks, and nurses are communicating with each other more efficiently. It is pretty incredible to see.

Google Docs has made this all possible, no mechanical engineers or big time money required. Check out this template in the Google Docs template gallery to try it out yourself.

Posted by: David Margolius, Clinic Coach, Southeast Health Center, Margolius@gmail.com