The job is relatively simple.

Just schedule a large number of medical staff with different tasks and team requirements, sometimes for continuous 24-hour shifts, with specific rotation rules. Include with that first and second on-call shifts and expertise groups, the normal vacation and off requests-all the while being sensitive to overscheduling and back-to-back shifts.

In truth, it sounds like a nightmare. And it's the type of nightmare doctors, nurses and office managers, who spend an estimated 40 hours a month with just initial scheduling, must deal with on a regular basis.

Enter Doctors on-Call Schedule (DOCS), a customized, Web-enabled medical scheduling program that not only designs schedules for the needs and constraints of medical staffing, but considers work history and equalizes the number of shifts each staff member works. DOCS, claims its developer, has the ability to reduce scheduling costs by 80 percent, or $250,000 annually at a 1,000-bed hospital.

DOCS is the brainchild of Don Scipione, president of Acme Express Inc., a Cleveland application software development company. Acme has developed accounting, truck routing, and scheduling software that solves complex combination problems. Scipione got the idea to apply his logistical programming skills to medical scheduling after talking to his brother, an anesthesiologist in Tucson, Ariz.

"Medical staff scheduling is the most complex type, because of the various kinds of constraints," he says.

Although the initial programming for DOCS was accomplished in less than a year, Scipione went through three National Institutes of Health Small Business Innovation proposals and one government shutdown before he received funding to complete the first phase of the project. After a feasibility study at University Hospitals, DOCS can boast it is being used for scheduling in 40 practices and hospitals. Not bad when you consider Scipione has only been advertising it through a Web site.

So, how does the software work? Easy, Scipione says. "(The) accounting framework is combined with an optimization procedure that attempts to find a schedule for which all of the accounts are simultaneously in balance. This is done by searching for a schedule which minimizes an objective function, defined as the sum over all individual accounts … of the magnitudes of the individual account balances, divided by the number of the accounts."

If the solution sounds as complicated as the problem, it's because mathematically, it is.

Scipione, originally an elementary particle physicist, developed this software incorporating a two-stage algorithm function using something called the Monte-Carlo shuffling process. It's the Monte Carlo shuffling that makes DOCS more than just a scheduling database.

In layman's terms, the idea is this: DOCS first takes all of the pertinent information needed to schedule - the number of shifts, who is qualified to work the shifts, vacations and time off - then calculates the original schedule. In the second round, the software accounts for the number of shifts each staff member has worked and reconfigures (shuffles) the schedule to distribute the shifts fairly - hence the term Monte-Carlo shuffling.

The goal is to have the most equitable schedule possible with the fewest number of scheduling errors.

Another unique aspect of the DOCS software is the fact that it is Web enabled. First, this means no on-site set-up. DOCS works within a Microsoft platform, and all a user needs is a browser and Excel software. Clients dial up to the DOCS site and work off of an off-site server.

It also means no on-site upgrades. DOCS users aren't bogged down with disks and lengthy hard copy manuals, and they aren't at the mercy of their IT person to load the software. All revisions, upgrades, and corrections are done at Acme.

That's one of the factors that drew Dr. Jane Findlater, program medical director at Region Three Hospital Corp. in Fredrickstown, New Brunswick, Canada, to Scipione's DOCS software.

Findlater explains, "The Web application is easier. When there is a problem, they can see what you are seeing and if you're stuck, they can help."

There is also a mobility factor. Because the application and data are accessible through the Internet, users can log on from anywhere and work on their schedules. Eventually, schedules will be able to be downloaded to handheld computers like the Palm Pilot.

Dr. Mark Nawrocki, director of obstetrics anesthesiology at University of Massachusetts Memorial Medical Center, logs onto the DOCS server at home because "all my work is done at home. My computer at work is not adequate."

Not only can Web enabled software be updated and corrected faster and easier, but everything the user does can be tracked.

"Part of infrastructure of the Internet is that we can track use and build the software to the user's need," says Scipione.

This allows Scipione to thoroughly analyze the software and its functions while it remains in a virtual environment.

Perhaps the irony of the situation is that the problem is complex, the technology is complicated, but the results are all about simplification. Nawrocki explains, "The flexibility translates into a lifestyle. It's about controlling the job instead of vice versa."

With all the mathematics and technology DOCS uses, the end result is that the scheduler and the schedulees can free themselves from what used to be a completely inflexible work schedule.

"In the old days, you could only trade shifts with one or two people," Nawrocki says. "You felt like you were tied to the job."

And what about other applications? Scipione predicts his software can be used in a variety of other occupations with scheduling issues similar to the medical profession. Nawrocki agrees, though the first extra application he sees is one that has nothing to do with his job.

"I've been toying with the idea of using it (DOCS) for my son's hockey team, to help schedule the ice time," he says.

SBN Magazine Cleveland, December 2000 issue Copyright 2000 Smart Business Network Inc. Reprinted with permission.

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