Workload Management in Telemedical Physician Triage and Other Knowledge-Based Service Systems

Telemedical physician triage (TPT) is an example of a hierarchical knowledge-based service system (HKBSS) in which a second level of decision agent (telemedical physician) renders a decision on cases referred to him or her by the primary level agents (triage nurses). Managing the speed-versus-quality trade-off in such systems presents a unique challenge because of the interplay between agent knowledge and flow of work between the two levels. We develop a novel model of agent knowledge, based on the beta distribution, and deploy it in a partially observable Markov decision process model to describe the optimal policy for deciding which cases (patients) to refer to the second level for further evaluation. We show that this policy has a monotone control-limit structure that reduces the fraction of decisions made at the upper level as workload increases. Because the optimal policy is complex, we use structural insights from it to design two practical heuristics. These heuristics enable an HKBSS to adapt effic...