On line scheduling

Online scheduling in a highly customized setting

Many health systems have begun offering the ability to schedule appointments online, either through their EHR or some other platform.  This is the norm for many other industries and people are beginning to expect this.  My organization is challenged to do this because we have allowed providers to customize their world to the nth degree.  For example, many only see a very narrow spectrum of patients despite credentials and experience that would allow them to see a broader subset.  They have also customized their visit types so that we literally have thousands of visit types.  This has made it very difficult to begin the process of piloting online scheduling.  To date, we have only been able to have a very few visit types, such as routine follow-ups because the providers have such specific templates that our IT folks would have to build an impossibly complex process.  Examples might be a neurologist who only sees headache patients on Tuesday mornings for 45 minute visits for new patients and post concussion visits in sports clinics on Fridays for 1 hour.  Each doc has been allowed to customize visit type, clinic times, etc, etc.  Many of these docs are very successful researchers who only want to see patients who have the condition on which they are doing research.

So, the problem really is one of culture where we don’t historically tell doctors what they can and can’t do and then how do we simplify all these visit types to make it possible to do online scheduling.  As additional background, for the few types of visits we have been able to schedule online, the overwhelming feedback has been that it is a very positive experience.


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Participant comments on On line scheduling

  1. We have ability for patients to schedule online and it was a slow roll out due to provider pushback. We only have a couple of options for patients to schedule the type and it really is based on time- an acute visit or physical. We started this with my office and would only allow a couple of those spots on the schedule each day. As we gained experience that patients were picking the right type of visit (not wasting our time with too long of visit for the problem) and showing up (no show rate is lower we have found) we’ve opened all visits up to schedule this way, though most are still done by phoning in. As you mentioned patients love it. You need to make it manageable by limiting the types of visits and get some small pilot groups to champion it. As they seen that its a win that will spread. We started it in Primary Care.

  2. Online scheduling is extreme challenging when we are dealing with highly spesialized area. It is far more easier when we can provide web site contact (chat) or mobile contact number where we can advise the customer. More easier it is in chronic diseases where customers need monthly, annually to visit doctor e.g. in certain chronic diseases. Also the group of customers is important at least at the beginning. Younger patients learn quickly. Piloting is extremely important, and you need excited people to champion the model. When we know the visit types etc for certain doctor, we can also customize the IT so that online scheduling will work smoothly.

  3. We have had the same experience. Super specialized providers who only see a limited subset of patients, and often expect those patients to undergo prescreening by other (RN or APP) that further complicates online or patient driven scheduling. Frankly, we have only had success in a very limited number of screening and simple scenarios (e.g. mammography, skin cancer screening check). However, discussion has started to put the burden of the solution on the providers– within this section/division/group of subspecialists they need to create a coverage model whereby they provide certain inpatient/outpatient services with consistency. Once this has been completed (currently in process), they then would be expected to create outpatient scheduling templates to reflect those visit types and open these online to patients (likely will be a pilot in one of our more innovative centers).

  4. We have many providers in a variety of specialties that allow for on-line scheduling and are currently opening up more physician schedules to allow for this. We have several options for on-line scheduling including our portal, website and a link from external sources such as Healthgrades to do this. The on-line scheduling function is working well. We have found that 67% of the patients utilizing this functionality have commercial insurance. We have also found that patients utilizing this functionality have a lower no show rate than patients booking via other methods.

  5. Steve, I have to agree with the first comment. Online scheduling is extremely difficult and burdensome for highly specialized practices and I have found better traction in primary care or specialties that have excess capacity and aligned incentives to fill that capacity. That said, specialties utilizing online scheduling often require a strong set of filters that can drive up labor costs.

    I have three questions: 1.) Are there incentives that align this initiative for these physicians e.g. wRVU/production compensation or access incentives? 2.) Why is your organization looking to this tool I.e. Enhancing patient experience, shifting patient demographics, excess capacity? 3.) Can you change control of templates? From your post, it appears the physicians have full autonomy over their templates. Can you re-route this to a dyad section chief/administrator approval and task these two individuals with consolidation. Mind you, this will be a slow an arduous process.

  6. We started online scheduling both in our specialty practices and primary care practices as a pilot first with few of our early adapters/ physician champions. We did it as a PDSA project for three months. As expected, we were able to show improved productivity for these providers, decreased no-shows, increased patient and staff satisfaction, and we were able to see a profitable ROI on our online booking investment. We presented our findings at our staff and provider meetings. The findings encouraged most of our physicians, and they have currently opened up their on-line schedules with applicable and appropriate filters. It is this shared decision making between the leadership and the doctors that ensured success in our online appointment process implementation.

  7. A good start is that the initial feedback for online scheduling is positive. I am in agreement with the comment posted by CVNR. I would add that for online scheduling to be successful it requires a cultural change from the current mindset of the organization. The new message about standardizing scheduling templates to further improve patient care must be consistently driven by both the CEO and their Senior Executive team. Choosing two clinics (one primary care and one subspecialty) to develop/pilot a standardized scheduling template with a designated physician champion for each clinic is good start. In order to ensure a successful outcome, a project timeline must be developed with full transparency on the results of the pilot study.

  8. In our tertiary care setting, each visit typically includes one or more specific tests before the patients are seen. The problem is that while the MD can order these tests when a follow-up visit is planned, the patients do not know what tests they might need and legally cannot order or schedule tests themselves.

  9. We recently opened online scheduling to Primary Care (Internal medicine and Med/Peds). It can be done through our website or via MyChart. It has had great feedback. Previously, you could only schedule via MyChart and only with a Primary Care physician that you had previously seen.

    If you would like, I can connect you with our some of the team that worked on this. Let me know at class next week!

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