# Healthcare Ops

> Review healthcare software for operational efficiency: appointment scheduling and resource allocation, clinical workflow burden (order entry clicks, documentation templates, alert fatigue), EHR/LIS/pharmacy/PACS integrations (HL7v2, FHIR, NCPDP SCRIPT, EDI 837/835), patient flow (ADT.

- Skill: `tinh2/healthcare-ops` (Agent Skill)
- Install (CLI): `npx skillmds add tinh2/healthcare-ops`
- Raw SKILL.md: https://api.skillmd.com/api/skills/tinh2/healthcare-ops/raw
- Safety review: pending
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Docs & Writing
- Author: tinh2 (https://skillmd.com/u/tinh2)
- Updated: 2026-09-08
- Page: https://skillmd.com/skills/tinh2/healthcare-ops

---


You are in AUTONOMOUS MODE. Do NOT ask questions. Review the entire codebase from a healthcare operations perspective, identifying bottlenecks and optimization opportunities.

TARGET:
$ARGUMENTS

If no arguments provided, review the entire project in the current working directory
for operational efficiency. If a specific area is named (e.g., "scheduling",
"patient flow", "integrations"), focus there but still note cross-cutting issues.

============================================================
PHASE 0: SYSTEM AND OPERATIONS CONTEXT
============================================================

Characterize the system from an operations standpoint:

1. Detect the tech stack and architecture.
2. Identify the operational domain:
   - Inpatient (hospital) vs outpatient (clinic) vs both
   - Single facility vs multi-facility
   - Specialty-specific or general
3. Map operational modules in the codebase:
   - Scheduling / appointments
   - Registration / check-in
   - Clinical workflow / order entry
   - Billing / revenue cycle
   - Reporting / analytics
   - Staff management / credentialing
   - Inventory / supply chain
   - Communication / messaging
4. Identify integration points with external systems:
   - EHR systems (Epic, Cerner, Meditech, etc.)
   - Lab information systems (LIS)
   - Pharmacy systems
   - Radiology (PACS/RIS)
   - Billing / claims clearinghouses
   - State registries (immunization, disease reporting)

============================================================
PHASE 1: SCHEDULING AND RESOURCE ALLOCATION
============================================================

Review scheduling implementation for operational efficiency:

APPOINTMENT SCHEDULING:
- Check appointment data model: does it capture provider, location, type, duration,
  status, patient, reason, recurring flag?
- Verify scheduling constraints: provider availability, room availability,
  equipment availability, patient preferences.
- Check for overbooking support (configurable overbooking rules by provider/type).
- Verify wait-list management implementation.
- Check for no-show tracking and predictive no-show modeling.
- Verify cancellation and rescheduling workflows.

RESOURCE ALLOCATION:
- Check for room/bed assignment logic.
- Verify equipment scheduling (shared resources across providers/departments).
- Check for provider template management (recurring availability patterns).
- Verify block scheduling support (surgical blocks, procedure rooms).
- Check for resource conflict detection and resolution.

CAPACITY PLANNING:
- Check for capacity utilization tracking.
- Verify appointment type duration analytics (actual vs scheduled).
- Check for demand forecasting features (seasonal patterns, growth).
- Verify bottleneck identification capabilities.

OPTIMIZATION OPPORTUNITIES:
- Flag scheduling logic that is purely FIFO without optimization.
- Check for batch scheduling capabilities (multiple related appointments).
- Verify support for multi-resource scheduling (provider + room + equipment).
- Check for travel time consideration in multi-location practices.

============================================================
PHASE 2: CLINICAL WORKFLOW EFFICIENCY
============================================================

Review clinical workflows for documentation burden and throughput:

ORDER ENTRY:
- Check order entry workflow step count (fewer clicks = less provider burden).
- Verify order set / favorites support (frequently used order bundles).
- Check for smart defaults based on diagnosis or encounter type.
- Verify order validation at entry (not just submission).
- Check for verbal/telephone order workflows with cosign requirements.

DOCUMENTATION WORKFLOW:
- Measure documentation template complexity (fields, required entries).
- Check for auto-population from previous encounters.
- Verify copy-forward functionality with review requirements.
- Check for structured documentation vs free-text balance.
- Verify speech-to-text or ambient listening integration points.
- Flag documentation workflows with more than 10 required clicks.

CLINICAL DECISION SUPPORT:
- Check for alerts and reminders implementation.
- Verify alert fatigue mitigation (severity tiers, suppression rules, snooze).
- Check for evidence-based order recommendations.
- Verify drug interaction and allergy alert implementation.
- Check for care gap identification (preventive care, chronic disease management).

REFERRAL MANAGEMENT:
- Check for referral workflow completeness (create, send, track, close loop).
- Verify referral status tracking.
- Check for closed-loop referral communication.
- Verify authorization tracking tied to referrals.

TASK MANAGEMENT:
- Check for clinical task queues (inbox, results review, message responses).
- Verify task assignment and routing logic.
- Check for task priority and escalation rules.
- Verify task completion tracking and SLA monitoring.

============================================================
PHASE 3: INTEGRATION ARCHITECTURE
============================================================

Review integration points for reliability and completeness:

EHR INTEGRATION:
- Check for HL7v2 / FHIR interface implementations.
- Verify ADT message handling (admit, discharge, transfer notifications).
- Check for bidirectional data sync vs one-way feeds.
- Verify error handling and retry logic on integration failures.
- Check for message queue / dead letter queue implementation.
- Flag any polling-based integrations that should be event-driven.

LAB SYSTEM INTEGRATION:
- Check for order-to-result workflow across systems.
- Verify specimen tracking integration.
- Check for auto-result filing with review workflows.
- Verify reference range handling across lab vendors.

PHARMACY INTEGRATION:
- Check for e-prescribing (NCPDP SCRIPT) implementation.
- Verify medication dispensing system integration.
- Check for formulary checking at point of prescribing.
- Verify controlled substance workflows (EPCS compliance).

BILLING INTEGRATION:
- Check for charge capture completeness (all billable events generate charges).
- Verify coding assistance integration (encoder, CAC).
- Check for claims submission workflow (EDI 837).
- Verify remittance processing (EDI 835) automation.
- Check for real-time eligibility verification (EDI 270/271).

EXTERNAL REPORTING:
- Check for state immunization registry reporting.
- Verify syndromic surveillance reporting.
- Check for quality measure reporting (CMS, HEDIS, MIPS).
- Verify public health reporting capabilities.

INTEGRATION RELIABILITY:
- Check for circuit breaker patterns on external calls.
- Verify timeout configuration on integration endpoints.
- Check for message retry with exponential backoff.
- Verify integration monitoring and alerting.
- Check for data reconciliation mechanisms.

============================================================
PHASE 4: PATIENT FLOW OPTIMIZATION
============================================================

Review patient flow management:

REGISTRATION AND CHECK-IN:
- Check for pre-registration capabilities (online, kiosk).
- Verify insurance eligibility verification at check-in.
- Check for patient identity verification workflow.
- Verify consent capture at registration.
- Flag manual data entry that could be automated.

ADMISSION / DISCHARGE / TRANSFER:
- Check ADT workflow completeness and status tracking.
- Verify bed management and bed board functionality.
- Check for discharge planning workflows (discharge criteria, pending items).
- Verify patient flow visibility (real-time census, wait times).
- Check for transfer coordination between units/facilities.

WAIT TIME MANAGEMENT:
- Check for patient wait time tracking.
- Verify queue management and prioritization.
- Check for patient notification capabilities (text when ready).
- Verify wait time analytics and reporting.

THROUGHPUT METRICS:
- Check for door-to-provider time tracking.
- Verify length-of-stay calculation and monitoring.
- Check for turnaround time tracking on key processes (lab, radiology).
- Verify throughput dashboards and real-time status boards.

============================================================
PHASE 5: REPORTING AND ANALYTICS
============================================================

Review reporting capabilities:

OPERATIONAL DASHBOARDS:
- Check for real-time operational dashboards (census, wait times, bed status).
- Verify provider productivity reporting.
- Check for financial performance dashboards.
- Verify patient satisfaction tracking integration.

QUALITY METRICS:
- Check for CMS quality measure calculation.
- Verify HEDIS measure support (if health plan related).
- Check for MIPS / APM quality reporting.
- Verify clinical quality dashboard implementation.

REGULATORY REPORTING:
- Check for meaningful use / promoting interoperability measure tracking.
- Verify state reporting requirements implementation.
- Check for Joint Commission / accreditation reporting support.

DATA EXPORT AND ANALYTICS:
- Check for data warehouse / analytics database feeds.
- Verify ETL pipeline implementation for reporting.
- Check for ad-hoc reporting capabilities.
- Verify role-based report access controls.

============================================================
PHASE 6: STAFF MANAGEMENT
============================================================

Review staff-related functionality:

CREDENTIALING:
- Check for provider credentialing status tracking.
- Verify license expiration alerting.
- Check for privilege delineation management.
- Verify CME / continuing education tracking.

SCHEDULING AND WORKLOAD:
- Check for staff shift scheduling.
- Verify workload balancing algorithms.
- Check for overtime tracking and alerting.
- Verify on-call schedule management.
- Check for float pool / resource pool management.

COMMUNICATION:
- Check for secure messaging between staff.
- Verify handoff/sign-out communication tools.
- Check for team-based care coordination features.
- Verify critical result notification workflows.


============================================================
SELF-HEALING VALIDATION (max 2 iterations)
============================================================

After producing the review, validate completeness and consistency:

1. Verify all required output sections are present and non-empty.
2. Verify every finding references a specific file or code location.
3. Verify recommendations are actionable (not vague).
4. Verify severity ratings are justified by evidence.

IF VALIDATION FAILS:
- Identify which sections are incomplete or lack specificity
- Re-analyze the deficient areas
- Repeat up to 2 iterations

============================================================
OUTPUT
============================================================

## Healthcare Operations Review

**Project:** [name]
**Stack:** [detected technologies]
**Operational Domain:** [inpatient/outpatient/both] | [single/multi-facility]
**Date:** [date]

### Operations Module Coverage

| Module | Implemented | Completeness | Efficiency Rating |
|---|---|---|---|
| Scheduling | [Yes/No] | [%] | [Excellent/Good/Fair/Poor] |
| Clinical Workflow | [Yes/No] | [%] | [rating] |
| Integration | [Yes/No] | [%] | [rating] |
| Patient Flow | [Yes/No] | [%] | [rating] |
| Reporting | [Yes/No] | [%] | [rating] |
| Staff Management | [Yes/No] | [%] | [rating] |

### Integration Health

| System | Protocol | Direction | Error Handling | Monitoring | Status |
|---|---|---|---|---|---|
| [EHR] | [HL7v2/FHIR/API] | [bidirectional/inbound/outbound] | [robust/basic/none] | [yes/no] | [OK/WARN/FAIL] |

### Bottleneck Analysis

| Area | Bottleneck | Impact | Root Cause | Recommendation | Effort |
|---|---|---|---|---|---|
| [scheduling] | [description] | [High/Medium/Low] | [code evidence] | [fix] | [S/M/L] |

### Workflow Efficiency Findings

| # | Module | File | Issue | Impact | Recommendation |
|---|--------|------|-------|--------|----------------|
| 1 | Clinical | path/to/file.ts | 15-click order entry flow | Provider burden | Implement order sets and smart defaults |

### Optimization Roadmap
[Ordered by operational impact and implementation effort]

1. **[Quick win]** -- [description], effort: S, impact: High
2. **[Major improvement]** -- [description], effort: M, impact: High
3. ...

============================================================
NEXT STEPS
============================================================

After reviewing the findings:
- "Run `/healthcare-api` to build missing integration endpoints."
- "Run `/clinical-data-review` to verify clinical data models support identified workflows."
- "Run `/medical-billing` to deep-dive on revenue cycle optimization."
- "Run `/healthcare-compliance` to ensure operational changes maintain regulatory compliance."
- "Run `/patient-engagement` to evaluate patient-facing features supporting operational goals."
- "Run `/perf` to benchmark integration and query performance on bottleneck areas."


============================================================
SELF-EVOLUTION TELEMETRY
============================================================

After producing output, record execution metadata for the /evolve pipeline.

Check if a project memory directory exists:
- Look for the project path in `~/.claude/projects/`
- If found, append to `skill-telemetry.md` in that memory directory

Entry format:
```
### /healthcare-ops — {{YYYY-MM-DD}}
- Outcome: {{SUCCESS | PARTIAL | FAILED}}
- Self-healed: {{yes — what was healed | no}}
- Iterations used: {{N}} / {{N max}}
- Bottleneck: {{phase that struggled or "none"}}
- Suggestion: {{one-line improvement idea for /evolve, or "none"}}
```

Only log if the memory directory exists. Skip silently if not found.
Keep entries concise — /evolve will parse these for skill improvement signals.

============================================================
DO NOT
============================================================

- Do NOT modify any code -- this is a review skill, not a build skill.
- Do NOT evaluate clinical correctness of medical logic -- focus on operational efficiency.
- Do NOT assume single-facility operations unless the code confirms it.
- Do NOT skip integration review -- integration failures are the top operational pain point.
- Do NOT ignore staff-facing UX -- provider burden directly impacts operational throughput.
- Do NOT recommend operational changes without grounding them in actual code/architecture evidence.
- Do NOT provide specific clinical practice recommendations -- stay in the software operations lane.
- Do NOT install external tools -- analyze codebase and configuration directly.