Are Your Schedulers Wired?

Are your schedulers stressed out from phones that won't stop ringing and appointment books that are impossible to decipher? Do your patients complain of inconvenient appointment times? Have you considered scheduling patients online? With 167.1 million Americans surfing the Internet - and online traffic doubling every two years - scheduling appointments online seems a likely next step for physician offices that are looking for increased efficiency through technology.

In the past, security and privacy were the top concerns for potential users of electronic appointment scheduling. Now security measures, including encryption, data signatures, and online information packets, are commonplace and ensure the protection of patient data online. More important, most online scheduling programs now transmit patient information within a Web site, where privacy can be protected. Simply scheduling by e-mail, on the other hand, may be less secure, because private information might be misdirected, for example, and inadvertently wind up in an employer's computer system.

Plan and prepare

Leslie Jebson, manager of specialty clinics operations at the University of Missouri Health Sciences Center in Columbia, agrees that encryption technology has become so sophisticated that security should not be a major concern. What should be a concern, he says, is ensuring a reasonable response time. "Making scheduling work requires the ability to give patients their first or second preference for an appointment - along with a good verification system," Jebson says.

Many experts acknowledge that response time is a big issue - and one that cannot be solved by technology alone. Putting an online scheduling system in place requires training, planning, and preparation. "Responsiveness has to do with staffing levels and efficiency," says Darrel Schmucker, information technology director for Sutter Health, a hospital and physician network in Northern California. "Patient expectations are always an issue to consider, along with privacy and confidentiality."

Jebson envisions a day when the electronic patient scheduling process, or "e-scheduling," will resemble the way airline tickets are purchased online: Patients will enter their condition, their physician's name, and several possible appointment dates, and in a moment's time the system will automatically confirm a date and time. Right now, Jebson believes, only a few practices' sites have reached this level of sophistication. For most practices, e-scheduling still requires someone to take appointment requests and match them with available times.

Easing the burden

For the 22 clinics he oversees, Jebson has developed a Web application called E-appointments that allows patients to request appointment times as well as update insurance and registration information.

on the secure Web site, patients enter information on a standard form, choosing which physician they want to see and at what time. "The information about the patient is more accurate, since they're entering it themselves," Jebson says. The request is then packaged into an e-mail that is sent to a customer service representative at the corresponding clinic, "who responds to the patient within 24 hours with three possible choices," he explains. A major benefit is that the system keeps the patients off the phones.

Rosemarie Nelson, a New York-based healthcare information technology consultant, agrees. "Since the calls are decentralized somewhere else, it really frees everyone up," she says. "Staff doesn't have to worry about the [appointment] book being there." With an electronic scheduling system in place, "the person at the front desk can truly be a greeter," clearing up roadblocks that can form at the front desk. "Nurses would be able to schedule patients [for their next appointments] from exam rooms, so the patients won't have to go back to the front desk," says Nelson.

She cautions that practice managers should take a step back before jumping onto the e-scheduling bandwagon. "Many practices simply don't have the infrastructure to approach a fully paperless office now. While vendors are hyping their solutions, practices are still concerned with reimbursements going down and how to cut costs," says Nelson.

Assess your needs

Indeed, the prudent practice will do its homework before adopting an e-scheduling program. Be sure that your practice - both staff and patients - is ready for the change and will take advantage of the benefits.

Access to technology is something to consider at the outset. "An issue with technology in general is accommodating both the haves and the have-nots," says Schmucker. "At one point in time, physicians had to deal with those who had a telephone and those who didn't - the situation now is probably not that much different."

Physicians are now using the Internet more in their practices. An American Medical Association (AMA) survey released last March found that 54 percent of physicians use the Internet at work, up from about 37 percent in 1999 - but access to the Internet is still not universal. The Commerce Department estimates that 60 percent of American households currently lack access to the Internet. For those households, traditional methods of appointment scheduling would have to remain an option. Find out if your patients are currently - or likely to become - Web users by surveying patients at checkout, when they phone in for appointments, or on new patient information forms.

If your patients can make the transition to online scheduling, make sure that your office can as well. Is the technology in place to use online scheduling? If not, are you ready to invest in new programs and upgrades? Compare vendors' products with your existing and future needs. Is your administrative system aging so that a complete, integrated system would be worth the investment? Or would a separate scheduling element make more sense? Today, systems available to healthcare providers can handle everything from scheduling and prescription refill requests to patient-physician e-mails and lab results; other systems let patients go online to update insurance data and complete registration forms. It's up to you to determine how much you need.

Be sure to work with your staff so that the transition goes smoothly, designating specific responsibilities, assignments, and backups. Develop guidelines for how soon inquiries will be answered and design a message flow for patients to get inquiries to specific staff members.

Finally, realize that e-scheduling only works if patients use it. Decide if you want to alert only existing patients or use the service to attract new patients. Activities as simple as sending out a patient mailing and posting a flier at the front desk to encourage e-scheduling can put existing patients in touch with your practice in just a click. Notify patients at the Web point of contact about which requests are appropriate for online scheduling, letting them know the hours during which online requests will be handled, and what to do if they have an emergency.

A solution that fits

"Electronic scheduling will continue to boom," Jebson predicts, citing comprehensive, Internet-capable management systems that combine back-office administration, computer support, and patient scheduling into one cohesive program. Software like this replaces entire management systems but requires extensive staff training. For smaller practices, there are Web-based applications that handle appointment and prescription refill requests, and allow physicians to e-mail patients newsletters and other information.

Whatever route you choose, take your time finding the right vendor and the program that will work for you. Invest in staff training and integrate the system into the practice's daily workflow. Then be sure you involve your patients by letting them know the practice offers e-scheduling - and by responding as promptly and as courteously to online inquiries as to phone calls.

Susanna Donato can be reached at editor@physicianspractice.com.

This article originally appeared in the November/December 2001 issue of Physicians Practice.