Patient Scheduling and Pre-Visit Intake: Let’s Give Patients What They’re Asking For

Several surveys about the online patient experience were recently released. It won’t surprise anyone who follows healthcare professionally—or who has used a healthcare portal—that patients are frustrated and disappointed. This article interviews a dozen experts to better understand why healthcare lags behind retail, finance, and other industries in serving customers online—and what we can do to improve the patient experience.

Surveys Show Widespread Dissatisfaction

This article was inspired by an outreach to me by the company Notable, which offers an API to interact with health records and automate routine tasks during patient interactions. The company surveyed more than a thousand people of varying genders and geographic locations (age and race weren’t tracked) to find out what they thought of the patient experience. I talked with Carle Falk, their Head of Research.

The most salient findings in the survey are listed in a short Business Wire article, but interesting details can be found in Notable’s own report. For instance, they found that 41% of patients have switched providers because of poor digital experiences.

Findings cover a lot of the patient experience, such as waiting room times—which have increased over the past few years—and time spent by doctors looking at computer screens instead of the patient, which averages 41% per visit.

Respondents made two specific requests, which reflect their expectation that a visit to the doctor should be as easy as an online restaurant reservation:

  • Patients would like to self-schedule visits online.
  • Patients would like to fill out all necessary forms before they arrive.

These requests are quite basic and can be easily satisfied with modern health care technology. Patients are not asking for remote monitoring, predictive analytics, or inspirational wellness reminders. Patients simply want incremental improvements over what they already know, just as people in Henry Ford’s early career were said to want a “faster horse.”

Wolters Kluwer’s Health division also recently commissioned a survey of 1,034 U.S. patients about their patient experience. The researchers tried to achieve a demographic balance. According to the survey, 80% of patients have follow-up questions after a health visit, and 94% of patients would like to have access to educational materials.

Finally, a survey by predictive analytics firm Carta Healthcare found that 83% of patients had to repeat information that they had previously provided at a doctor’s office. Also, 42% of respondents spent six minutes or more recounting their past medical history at every appointment. Results were provided by an online survey of 1,014 U.S. consumers. Carta Healthcare attributes the duplication to a lack of integrated medical systems at healthcare providers.

The Notable survey found, alarmingly, that 61% of patients gave up on scheduling appointments altogether because of the difficulties encountered during the process.

According to Carta Healthcare, one in five patients said the hassle of repeatedly providing their information made them less likely to return to that provider.

This article will explain how the patient experience can be improved, focusing on the two modest requests seen in the Notable survey. A follow-up article will cover the broader topic of connected care.

Why Is a Satisfying Online Experience So Hard?

Patients want to schedule a clinical visit like they schedule a restaurant reservation—so why can’t they?

Clinical visits are complex and come with many variables: insurance, patient type, provider preferences, lab requirements, etc. Scheduling patients with the right appointment therefore requires an understanding of each provider’s specific preferences and expertise.

Cynthia Davis, clinical transformation executive at Healthlink Advisors, says that many clinics are reluctant to let patients schedule visits online. The clinicians fear that the patient will choose the wrong doctor, time slot, or type of visit—or that the patient will enter critical information, such as medication names, incorrectly. Therefore, Davis advises starting small: Clinics should offer one or two slots per day for patient self-scheduling. More slots can be added as the clinic’s self-scheduling system is refined.

According to Davis, it’s also hard to offer an automated scheduling system when each doctor has specific preferences and requirements: patient type, time alloted for an initial or follow-up visit, and more. Establishing a common process is therefore important.

Davis says some of the attitudes toward self-scheduling, among both patients and doctors, are generational. Younger people are accustomed to online self-service, and therefore more likely to be comfortable self-scheduling their medical appointments.

Hari Prasad, CEO of Yosi Health, and Joseph Demmons, Application Integration Product Manager at Azalea Health, point out that patient self-scheduling portals are usually provided by the organization’s EHR vendor. For instance, MyChart was created by Epic—and Epic, notoriously, has little sensitivity and concern for the user experience. Epic’s system permits self-scheduling only for the most simple appointments.

When clinics rely on their EHR vendor for self-scheduling, they are almost always disappointed in the result. The patient portals provided by EHR vendors are difficult to use, can’t schedule complex appointments, and don’t take individual provider preferences into account.

According to Demmons, most software developers in health care are trapped in an obsolete approach. They design systems that favor the developers’ interests rather than those of the end-users.

Vendor Solutions

Stephen Dean, COO and co-founder of Keona Health, offered a three-level taxonomy of solutions to patient problems.

  1. At the lowest level, the clinician does whatever they can to bulid on the conventional patient portal, which is usually provided by the EHR vendor. Dean says this is relatively old technology that facilitates only very basic scheduling, such as a generic “new patient visit”. Everything else gets sent as a “schedule request” to the call center or front desk, who then must contact the patient to book the appointment. Typically, he says, these sites can schedule only 10-15% of all visit types online.
  2. Get a third-party, automated check-in platform such as Phreesia. These AI-powered platforms digitize many paper-based processes. Because their check-in logic accounts for more variables, such as insurance and provider preferences, than EHR portals do, their scheduling algorithms allow 30-50% of visits to be self-scheduled online.
  3. Work with a patient access platform such as Keona Health. These platforms operate both online and inside the call center, and they therefore allow 50-90% of all visit types to be scheduled online. These platforms maintain a database of provider preferences, use AI to capture information from the call center, and support workflows unique to the call center location.

Interestingly, although Keona Health allows more than 90% of appointment types to be scheduled online, only 30% of their patients choose to do so. This number is still much higher than the industry-wide average of 10%.

athenahealth is one of the best-known companies for EHRs and collaboration in healthcare. I talked there with Curtis Sherbo, VP of product management for the patient experience, about their services.

Their services include scheduling, self check-in, consent forms, and advance copays—all of which can be performed without going through the clinician’s portal. Providers can configure questionnaires in the EHR for patient screening, which the patient can fill out through the platform.

Branden Neish, Chief Product Officer at Weave, said their platform gives patients what they want. A widget in the clinician’s portal lets patients self-schedule. The widget pulls information from the system and offers a drop-down list that lets the patient choose the type of treatment and a specific provider.

With the appointment in the system, the patient can then receive and fill out the necessary forms. Sometimes the patient’s mobile device already has information, such as their address and phone number, that is requested by the form. In this case, Weave can populate fields in the form automatically. Communication channels supported by Weave include phone calls, text, and email.

According to Prasad of Yosi Health, 82% of patients prefer a provider who offers online scheduling, and 44% said filling out forms is the worst part of the patient experience.

Yosi Health tries to reduce this friction in several ways. It is well documented that patients find it a barrier even to sign up for an account on a portal. Yosi Health dispenses with sign-ups and allows patients to schedule and fill out forms on any smartphones, desktops and laptops, etc.

Interacting without a traditional sign-up process raises the question of how to authenticate the patient. Yosi Health’s system uses a patient matching algorithm that matches the patient information available in the EMR, reinforced by a two-factor authenticator. This enables patients to securely access the system without the need for portal signup.

Having matched the patient, the system gets as much information as it can from the patient’s record, if they are in the clinical system already. The result is that visits can be scheduled online without the need for a phone call more than 85% of the time. Canceling and rescheduling are also easy.

Yosi Health also helps patients fill in forms without having to download an app or log in through a portal. The system is fully device agnostic. Yosi Health finds that 80% of patients fill in their forms before the visit, saving 14 minutes per patient at the clinic.

Clinicians can use a no-code generator to design the questions asked of the patient during scheduling and the check-in process, such as whether they are an existing patient and whether the appointment requested is a follow-up. Such automation addresses pressures on clinicians and helps reduce staff burnout.

Let’s Talk Interactive, Inc. (LTI) hooks into the EHR’s scheduling system—which is normally used just by providers—and opens it up for self-scheduling by patients. Patients have dashboards where they can find their current provider or request a visit with the next available provider. According to Art Cooksey, Founder and CEO, patients can also update documents in the dashboard.

Thus, self-scheduling and filling out forms in advance should be available to most patients. What about more sophisticated forms of online interaction with patients? A follow-up article will cover some options.

About the author

Andy Oram

Andy is a writer and editor in the computer field. His editorial projects have ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. A correspondent for Healthcare IT Today, Andy also writes often on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM (Brussels), DebConf, and LibrePlanet. Andy participates in the Association for Computing Machinery's policy organization, named USTPC, and is on the editorial board of the Linux Professional Institute.

   

Categories