Basics of Healthcare: Scheduling
A tale as old as time
You haven’t seen your Primary Care Physician (PCP) in 3 years. But, now your spouse is concerned that she heard you gasping for air while you sleep. You finally get guilted into making that appointment.
You call and set up an appointment. The very nice scheduler says “we have opening next week!”
You’re thinking this is amazing!
Then the scheduler lists off the dates and times that are available, and right about now you realize why you haven’t seen the PCP in 3 years
“We have an appointment next Wednesday at 10 AM, next Thursday at 11 AM. OH! We even have a Noon appointment. Those are usually not available!”
You like many responsible adults, just like the nice person on the phone, work to support your family. You, also like the majority of people, work during the day. You drive 45 mins to work and only get a 30 minute lunch break. You are now deciding if this medical condition is worth having to take a sick day from work, but you are trying to save them for that trip you have been planning for 2 years now.
Now let’s see how the rest of this story plays out:
You: “Are there any openings after 4 or even 5 pm?”
Scheduler: “I will tell you that we usually don’t have many available at those times, but I will check!”
You: “So, you’re saying there is a chance!” [awkward laughter]
Scheduler: [click...clack…click…clack…click…click…click] “Soooo…we do have an opening in 5 weeks on Tuesday at 4:30…does that work for you?”
You: “Oh man, I was hoping for something sooner…”
Scheduler: “I am sorry. Unfortunately, that is the earliest date we have for that time. What I can do is put you on our list of call backs. If someone cancels at those times we can call you to reschedule?”
You: “Ok, we can do that I guess. Let’s schedule that appointment for 5 weeks from now and put me on that list.”
You’re thinking to yourself I hope I don’t die of asphyxiation. My spouse can save me, right? Maybe we should take some CPR classes?
I mean it only took 2 years for you to make this appointment since your spouse brought it up the first time…
Also, you just realized that your lunch is almost over and you now have to scarf down your food and get back to work.
We all know this story. Almost all of us have had this interaction before. Now let’s look at this interaction from the other perspective.
PCP’s are swamped. They are already double booking appointments to accommodate their patients.
One other thing we all have to understand is that schedulers, physicians, nurses, pharmacists, etc. are people too. They have families to go back to as well. They also have baseball games and recitals they would love to go to. They can’t because they are trying to increase patient satisfaction because the practice got a complaint about waiting too long to see them. So now they have increased their hours to accommodate even more patients. Then they go home late eat dinner and then spend an hour with their family before putting their kids to sleep. Then they go into their office and finish up their notes for the day.
The whole staff knows that you are working the day shift and would like to have a later appointment. That is why they are always gone first. They are trying to be accommodating by creating a list to call when one of those precious appointments becomes available.
Now, what does this have to do with digital health?
Telehealth
In this scenario, you could have taken this appointment during lunch, at work. All you need to do is find a private place or just go to your car. It is not ideal, but it is better than the alternative.
Providers may not have to extend their hours. It also allows for getting on emergency calls with their patients.
To me, the best way to handle a hybrid model for practices is by grouping all televisits up into half a day. Like making every Wednesday you schedule all your televisits from 8am-12pm or whatever suits your practice best!
Combine this with Remote Patient Monitoring (RPM) and you have yourself something amazing!
Here are some free telehealth platforms that you can try and see if it is a good fit for you.
Google Meet - Yes it is HIPAA compliant you need to fill out a BAA. It is all explained in the link
Artificial Intelligence (AI)/Machine Learning (ML)
This is a perfect place to incorporate AI/ML or just rudimentary logic.
The most basic implementation is for your patient to fill out a simple form as to when they would like appointments. Then your system just automatically sends them a message, email, call, or all of the above about scheduling an upcoming appointment. This helps you retain your patients, and not lose them to follow-up. It can also show you that maybe you need to be open longer on Monday but you can close early on Thursday based on how your patients respond.
That sounds great and all but what about new patients? You can build in that logic. Only having new patients at certain times. Or blocking off an extra 15 - 30 mins after to give you a buffer to chart etc. The system can be as smart as we make it. The possibilities are literally endless.
A lot of times we don’t remember to take care of ourselves. Sometimes a text from your PCP saying “Hey Zain! We haven’t seen you in a while. We have an appointment open on September 15th at 4 pm. Would you like to schedule an appointment at this time?” makes it that much easier. Bonus points if I can just hit “YES” and it is done!
Now your scheduler is freed up to do more important things. Like, help with some other administrative tasks to take off your plate such as blocking off your shiny new schedule. I mean there is no shortage of work in a clinic!
If you really want to get fancy you can incorporate AI/ML. The caveat with this is that you need a good amount of data. AI/ML models are only as good as the data they have to work with. There is a very common saying which goes “garbage in equals garbage out.” The worse the data is, the worse your model will be and vice versa.
Let’s say you have a lot of good data. Then it’s just autopilot from there. The system takes care of everything. Technically your existing patients wouldn’t even have to fill out anything. The algorithm could look at previous visits and decipher what days and times they like best!
Yes, these are not perfect and will require some trial and error. But to me it is about moving forward. The way it is being done now is not good.
We have all these solutions being made for this and that. Let’s fix the basic part first. Let’s make it easier for all parties to connect, and allow everyone to get control of their schedules back!
Thank you so much for your support! Please do not hesitate to reach out if you have any questions.
I hope you have a great day!