{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T23:48:46Z","timestamp":1777852126596,"version":"3.51.4"},"reference-count":70,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T00:00:00Z","timestamp":1582243200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Informatics J"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>Scheduling of resources and patients are crucial in outpatient clinics, particularly when the patient demand is high and patient arrivals are random. Generally, outpatient clinic systems are push systems where scheduling is based on average demand prediction and is considered for long term (monthly or bimonthly). Often, planning and actual scenario vary due to uncertainty and variability in demand and this mismatch results in prolonged waiting times and under-utilization of resources. In this article, we model an outpatient clinics as a multi-agent system and propose an intelligent real-time scheduler that schedules patients and resources based on the actual status of departments. Two algorithms are implemented: one for resource scheduling that is based on predictive demand and the other is patient scheduling which performs path optimization depending on the actual status of departments. In order to match resources with stochastic demand, a coordination mechanism is developed that reschedules the resources in the outpatient clinics in real time through auction-bidding procedures. First, a simulation study of intelligent real-time scheduler is carried out followed by implementation of the same in an outpatient clinic of Aravind Eye Hospital, Madurai, India. This hospital has huge patient demand and the patient arrivals are random. The results show that the intelligent real-time scheduler improved the performance measures like waiting time, cycle time, and utilization significantly compared to scheduling of resources and patients in isolation. By scheduling resources and patients, based on system status and demand, the outpatient clinic system becomes a pull system. This scheduler transforms outpatient clinics from open loop system to closed-loop system.<\/jats:p>","DOI":"10.1177\/1460458220905380","type":"journal-article","created":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T07:58:44Z","timestamp":1582271924000},"page":"2383-2406","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":30,"title":["An intelligent real-time scheduler for out-patient clinics: A multi-agent system model"],"prefix":"10.1177","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0811-1499","authenticated-orcid":false,"given":"Jyoti R","family":"Munavalli","sequence":"first","affiliation":[{"name":"CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands; BNM Institute of Technology, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shyam Vasudeva","family":"Rao","sequence":"additional","affiliation":[{"name":"Forus Health, India; Maastricht University Medical Centre, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aravind","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Aravind Eye Care System, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"GG","family":"van Merode","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Centre, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,2,21]]},"reference":[{"key":"bibr1-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.23.2848"},{"key":"bibr2-1460458220905380","unstructured":"Hopp WJ, Spearman ML. Factory physics: foundations of manufacturing management. Irwin, CA: The McGraw-Hill, 1996, p. 668."},{"key":"bibr3-1460458220905380","volume-title":"Annual international conference of the IEEE engineering in medicine and biology society, San Diego, CA","author":"Khanna S"},{"key":"bibr4-1460458220905380","volume-title":"AMIA Annual Symposium proceedings","author":"Plasters CL","year":"2003"},{"key":"bibr5-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-25920-3_6"},{"key":"bibr6-1460458220905380","first-page":"1665","volume-title":"Medinfo 2007: proceedings of the 12th world congress on health (medical) informatics; building sustainable health systems, Brisbane, QLD, Australia","author":"Khanna S"},{"key":"bibr7-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1080\/095372801750397716"},{"issue":"5","key":"bibr8-1460458220905380","first-page":"393","volume":"90","author":"Mansdorf BD","year":"1975","journal-title":"Public Health Rep"},{"key":"bibr9-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1097\/00004630-200105000-00014"},{"key":"bibr10-1460458220905380","doi-asserted-by":"publisher","DOI":"10.2753\/MIS0742-1222250105"},{"key":"bibr11-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1016\/j.eswa.2013.02.015"},{"key":"bibr12-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1007\/s00769-003-0731-8"},{"key":"bibr13-1460458220905380","volume-title":"Tactical planning in Healthcare using approximate dynamic programming","author":"Hulshof PJH","year":"2014"},{"key":"bibr14-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1023\/A:1019767900627"},{"key":"bibr15-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1177\/0972063415625570"},{"key":"bibr16-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2010.02.013"},{"key":"bibr17-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1016\/j.artmed.2008.07.019"},{"key":"bibr18-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1177\/0972063417727627"},{"key":"bibr19-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2004.02.007"},{"key":"bibr20-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1007\/BF02642481"},{"key":"bibr21-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1057\/jors.2013.56"},{"key":"bibr22-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1016\/j.cie.2014.03.026"},{"key":"bibr23-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1016\/S1386-5056(03)00008-X"},{"key":"bibr24-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1016\/j.cie.2014.05.006"},{"key":"bibr25-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2105-13-S14-S4"},{"key":"bibr26-1460458220905380","doi-asserted-by":"publisher","DOI":"10.5334\/ijic.812"},{"key":"bibr27-1460458220905380","author":"Munavalli JR","journal-title":"Health Informatics J"},{"key":"bibr28-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-7717.2011.01260.x"},{"key":"bibr29-1460458220905380","doi-asserted-by":"publisher","DOI":"10.3109\/13561820.2012.724125"},{"key":"bibr30-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1007\/s10458-009-9086-9"},{"key":"bibr31-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1177\/0951484818813488"},{"key":"bibr32-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1111\/j.1937-5956.2011.01220.x"},{"key":"bibr33-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-540-89674-6_13"},{"key":"bibr34-1460458220905380","doi-asserted-by":"publisher","DOI":"10.7763\/IJMLC.2015.V5.482"},{"key":"bibr35-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1007\/s10916-015-0376-2"},{"key":"bibr36-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-13-3"},{"key":"bibr37-1460458220905380","volume-title":"Proceedings of the 2004 ACM symposium on applied computing, Nicosia, Cyprus","author":"Paulussen TO"},{"issue":"01","key":"bibr38-1460458220905380","volume":"23","author":"Nieves JC","year":"2014","journal-title":"Int J Artif Intell Tool"},{"key":"bibr39-1460458220905380","first-page":"149","volume-title":"Coordination and agent technology in value networks","author":"Paulussen TO","year":"2004"},{"key":"bibr40-1460458220905380","volume-title":"Proceedings of the eighteenth international joint conference on artificial intelligence (IJCAI-03)","author":"Paulussen TO"},{"key":"bibr41-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1007\/3-540-45634-1_1"},{"key":"bibr42-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1080\/02564602.2001.11416972"},{"key":"bibr43-1460458220905380","volume-title":"Engineering in medicine and biology 27th annual conference","author":"\u0160tiglic G"},{"key":"bibr44-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1007\/s11761-007-0012-1"},{"issue":"4","key":"bibr45-1460458220905380","first-page":"375","volume":"1","author":"Z\u00f6ller A","year":"2006","journal-title":"Int Trans Syst Sci Appli"},{"key":"bibr46-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1109\/JSAC.2008.080919"},{"key":"bibr47-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1016\/j.cie.2008.08.018"},{"key":"bibr48-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1007\/s10458-006-9009-y"},{"key":"bibr49-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1016\/j.eswa.2011.07.017"},{"key":"bibr50-1460458220905380","volume-title":"AAAI fall symposium on plan execution, Massachusetts Institute of Technology, Cambridge","author":"Williamson M"},{"key":"bibr51-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1109\/TSMC.1987.6499280"},{"key":"bibr52-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1016\/S0007-8506(07)60137-1"},{"key":"bibr53-1460458220905380","first-page":"168","volume":"4","author":"Schumann R","year":"2008","journal-title":"Comm SIWN"},{"key":"bibr54-1460458220905380","unstructured":"Ramani KV, Mavalankar DV, Govil D. Strategic issues and challenges in health management. Los Angeles, CA: SAGE, 2008, p. 227."},{"key":"bibr55-1460458220905380","unstructured":"Prahalad CK. The fortune at the bottom of the pyramid: eradicating poverty through profits (Revised and Updated 5th Anniversary ed.). Upper Saddle River, NJ: Wharton School Publishing, 2009, p. 432."},{"key":"bibr56-1460458220905380","unstructured":"Activity-report\n                      . Madurai, India: Aravind Eye Care System, 2014\u20132015, p. 76."},{"key":"bibr57-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1162\/itgg.2007.2.4.50"},{"key":"bibr58-1460458220905380","unstructured":"Mehta PK, Shenoy S. Infinite vision \u2013 How Aravind became the greatest business case for compassion. San Francisco, CA: Berrett-Koehler, 2011, p. 336."},{"issue":"1","key":"bibr59-1460458220905380","first-page":"447","volume":"2","author":"Chaudhary Modi AG","year":"2012","journal-title":"Zenith Int J Multi Res"},{"key":"bibr60-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1162\/itgg.2007.2.4.35"},{"key":"bibr61-1460458220905380","doi-asserted-by":"publisher","DOI":"10.4324\/9781315818962"},{"issue":"67","key":"bibr62-1460458220905380","first-page":"40","volume":"21","author":"Natchiar G","year":"2008","journal-title":"Comm Eye Health"},{"key":"bibr63-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1016\/j.csda.2004.07.013"},{"key":"bibr64-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-5823.2005.tb00250.x"},{"key":"bibr65-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1287\/ijoc.12.3.237.12636"},{"key":"bibr66-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1109\/4235.585892"},{"key":"bibr67-1460458220905380","unstructured":"Liker JK. The Toyota way: 14 management principles from the world\u2019s greatest manufacturer. New York: McGraw-Hill, 2004, p. 330."},{"key":"bibr68-1460458220905380","unstructured":"Hopp WJ, Spearman ML. Factory physics-foundations of manufacturing management. Irwin, CA: McGraw-Hill, 2001, p. 698."},{"key":"bibr69-1460458220905380","doi-asserted-by":"publisher","DOI":"10.1080\/00207543.2011.575895"},{"key":"bibr70-1460458220905380","doi-asserted-by":"crossref","unstructured":"Mac Gregor Smith J, Tan B. Handbook of stochastic models and analysis of manufacturing system operations. International series in operations research and management science. Vol. 192. New York: Springer-Verlag, 2013, p. 373.","DOI":"10.1007\/978-1-4614-6777-9"}],"container-title":["Health Informatics Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1460458220905380","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1460458220905380","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1460458220905380","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:31:03Z","timestamp":1777501863000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1460458220905380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,21]]},"references-count":70,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1177\/1460458220905380"],"URL":"https:\/\/doi.org\/10.1177\/1460458220905380","relation":{},"ISSN":["1460-4582","1741-2811"],"issn-type":[{"value":"1460-4582","type":"print"},{"value":"1741-2811","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,21]]}}}