See More Patients Sooner Without Working Longer Hours

Kenneth J. Terry, MA


February 06, 2013

Dear Doctor, I'm Emailing You for an Appointment

Meanwhile, a growing number of practices are offering online scheduling, an approach that requires the use of a patient Web portal. Practices can let patients either request appointments online or make online appointments themselves.

Online appointment requests are a standard feature of patient portals. About 20% of practices have such portals today, and the number is expected to grow rapidly because of the meaningful use stage-2 requirement that eligible professionals share electronic health records (EHRs) with patients.

When EHR vendors provide the portals, the interfaces with scheduling applications are usually smooth, Nelson says. Third-party portal vendors such as RelayHealth and Intuit also supply good interfaces, but how well they work depends partly on the practice management system.

Patients like the ability to request appointments online because they can do it anytime and can make the requests on their smartphones, she notes. Staff members also like it because, once they get used to checking the portal regularly for new requests, they find that it decreases the number of phone calls they have to take.

Bagley agrees that online scheduling is more efficient than phone calls. But he says it's better to let patients request appointments than to make them online. "I think it probably makes more sense for people to request an appointment and then have some criteria by which you'd decide whether they need an appointment or can have their problem solved in another way. An appointment request probably requires some triage, which is what's happening on the phone."

Online appointment making, he adds, can work in a fee-for-service environment where the main goal is to get people into the office. But in a capitated practice, "you begin to do demand management," he says, and some type of triage is necessary.

OMG, I Can Make My Own Appointment!

In the view of CSC's Metzger, it's "unusual and challenging" to let patients make their own appointments online. First, trusting patients to triage themselves is "a real mindset transformation," she says, and you've got to decide how much of your appointment book you want to open to patients. Also, this approach could present problems if a physician goes home ill or is called away to the hospital suddenly, she notes.

"People will continue to make these online appointments unless somebody blocks off the missing doctor's schedule. You can work around it, but there's a longstanding practice of using a human scheduler, who's working closely with a triage nurse."

Finally, Metzger points out, most vendor-provided portals aren't capable of letting patients make their own appointments.

Nelson, the MGMA consultant, agrees that practices need special software for patients to make their own appointments on a portal. "Few leading practice management systems allow patients to go online and schedule. So, most groups that do this are doing it with another application.

"The question is whether you want your front-desk staff to have both apps open, because typically they'll be doing some kind of scheduling themselves, and you want it all on the same schedule. Or are you going to have some kind of interface, so every time a patient makes an appointment, it's passed to the scheduling system?"

Two third-party applications that enable online appointment making on portals, she says, are eAppointments and MyScheduler. Bender cites another product called ZocDoc that has a bidirectional interface with his practice management system.

Bender's and Mullins's groups allow online appointment making, and both say that it complements open-access scheduling. Bender says his practice does it because "customers want this kind of functionality" and because it reduces practice overhead.

Mullins's practice opens about half of its appointments to online appointment making. Patients can book any type of visit they want, but the practice blocks out some of its same-day appointments so that they'll be available to people who call or walk in that day. Patients love online scheduling because of the convenience and because they can pick visit times that work for them, she says.

Pick the Right Approach for Your Practice

Patient scheduling is a complex process that requires careful thought and planning. Few doctors are ready to leap from conventional sequential scheduling to open-access scheduling in one fell swoop.

But taking an intermediate step -- such as experimenting with carve-out scheduling -- lets you test the temperature of the water by offering patients incrementally greater access. Not only should this help to improve continuity of care at a time when reimbursement is increasingly being linked to outcomes, but it also will be increasingly necessary to remain competitive as more doctors make it easier for patients to get appointments.