Scheduling Care Delivery

"As the owner of a thriving general dentistry practice, we deal daily with a simple but significant problem: scheduling," says Dr. Jeff Tocci, DDS, owner of a Boston-area dental practice. "Without a doubt, advances in client connectivity to data from appointment schedules to dental records will reshape the business of any primary-care physician or specialty doctor and greatly increase the satisfaction of the care recipient." What's the problem with the seemingly simple issue of scheduling?

Outside the world of hospitals, a family's principal home-care organizer (PHCO, which in many cases, is Mom) is the chief interface to the doctor's office, primarily for scheduling and keeping appointments. Putting aside the increased challenges of dual-working families, home schedule orchestration has reached new levels of stress. Statistically speaking, the average family with 2.7 kids plays two sports per season, takes piano lessons, and attends drama classes and numerous birthday parties, not to mention holidays and vacations away from home. In turn, this makes scheduling and keeping doctors appointments challenging. Often, the primary health-care giver, such as Doctor Tocci, bares the cost and trouble for any scheduling snafus.

"I don't mind working part of my Saturday. I don't mind working Tuesday evenings and taking appointments until 8 or 9 P.M. Offering extended hours allows us to better meet people's scheduling needs. What is excruciating is when an appointment doesn't show up or cancels hours before the scheduled time," continues Dr. Tocci. "This costs me significant lost money and increased levels of aggravation, but most importantly it detracts from another patient who could have benefited from that time. Many doctors have begun charging customers for missed appointments, and this then leads to poor patient sentiments and usually an irate phone call or two. What we need is a better conduit of contact to the primary home-care organizer so that we can be flexible, accommodating, and punctual."

UK Loses $300M Due to No-Shows

The United Kingdom's health-care system, the NHS, states that missed appointments are costing it about $162 million pounds (approximately $300 million) annually.^[4] More than one million appointments are missed each year in the UK (between general practitioner and nursing appointments). Of these missed appointments, 55 percent are blamed on the client simply forgetting the date or time. Missed appointments also rob a needy patient of an earlier time and more prompt service and greatly add to stress and costs. Worldwide, the cost of missed appointments could easily be more than $2 billion. NHS is exploring the use of electronic messaging to improve scheduled appointments and gaps in service. Ealing Hospital in West London is one of the hospitals (among others) using short message service (SMS) (text messages to patient's cell phones) to remind patients of routine outpatient and MRI scan appointments.^[5] Text reminders are automatically sent directly to the patient's cell phone some amount of time prior to the appointment. The fully connected Inescapable Data world is all about minimizing or eliminating gaps.

^[4] http://www.pharma-lexicon.com/medicalnews.php?newsid=12446.

^[5] http://www.cnn.com/2004/TECH/08/12/hospital.texts/.

Here's how the typical dentist appointment is scheduled: As the PHCO leaves the dentist office (often with 2.7 children in tow), he or she haphazardly agrees to the next visit date suggested by the office staff without verifying suitability against the paper-based, kitchen wall-mounted calendar at home, but fully intends on taking the folded appointment-reminder home and reconciling it later. Other distractionsa soccer pickup and a list of phone calls to return when back at homefollow the office visit. Soon, the PHCO has long forgotten about recording the appointment. In an effort to achieve higher appointment success, doctor offices often deploy the laborious and costly process of calling patients 24 to 48 hours in advance. Often, this is far too short of notice for the patient and the doctor to properly accommodate any changes. No-shows and stress abound. Although a small handful of techno-savvy PHCOs carry electronic personal organizers, such devices are far from pervasive. There is fertile ground for change, change enabled by convergence of pervasive technologies. Two years ago, the average PHCO did not carry a cell phone or even use the Web for e-mail communication. Today, many adults carry a personal communication device 100 percent of the time and use the Web at home to completely keep current with soccer schedules, schoolteachers, and myriad other life-important schedule-related events. Medical businesses can count on many clients possessing a cell phone and can appropriately exploit noninvasive asynchronous (but immediate) messaging for both parties' benefit.

Today, the majority of airline and hotel reservations are either made via the Net or researched via the Net (and then booked by a short phone call). Airlines and hotels are large industries with a relatively small set of big players. Whatever competitive feature one offers, such as online booking, the others naturally follow to keep pace with the competition. The community health-care delivery system, in contrast, is highly fragmented and run essentially by proprietors. However, small, fragmented businesses can offer services equal to the big players by using Inescapable Data technologies and leveraging large outsourcing firms for non-valueadd services.

Dr. Tocci elaborates on the opportunity:

We [doctors] are more willing than ever to outsource various aspects of our non-value-add business. I don't need to be a Webmaster; I have an outside firm that manages my Web presence. In the same way, I don't need to be in the business of scheduling appointments. It's mechanical. Moreover, customers want self-service. They want to scan the schedule themselves. They want to find a day and time where they can get both kids in at the same time based on what procedure is needed and the availability of my staff against their busy schedule. They want to do this scheduling dance late in the evening, long after my staff has gone home, from the comfort of their home computer table or from their PDA on the soccer field.

Most community health-care providers now use PC-based scheduling software. Some are even capable of exposing their scheduling tools through their own Web pages. Scheduling can also be outsourced and managed by service bureaus that can provide the technology interface at high speed and low cost through scale (quite likely the same providers of the doctor office Web presence today). So, when we combine these services with Inescapable Data devices we have the makings of an advance. Reminders can be automatically sent both by e-mail and text messages at recurring intervals prior to the appointments (one week, day before, four hours before, and so on). In addition, the PHCO can be in direct contact with the provider's office and can monitor current office conditions. Are appointments running half an hour late, an hour late? Has the doctor been called out on an emergency? Has an earlier appointment opportunity opened up due to a cancellation?

"It seems simple and obvious," observes Dr Tocci. "The values are very high for both my practice and my clients." As technology has advanced and grown into our environments, we develop certain life-efficiency expectations, such as being able to find an automated teller machine (ATM) within a short walk from anywhere. So too, as Inescapable Data technologies advance, we may well come to expect "connected schedules" for all consumer businesses. Those not offering these kinds of services will lose out to competitors that doand, not just dentists and pediatricians, but every health-care provider, car repair shop, and hair stylist. Those who have crossed the connectivity divide will look for connectivity and scheduling efficiency in their service providersconnectivity made possible by the growing pervasiveness of personal communication devices (cells and PDAs), combined with digital cellular and/or WiFi services connected to care providers using the Web-based services for self-scheduling.

Online, personal services scheduling is still in its infancy. It is not here today. But this will change with astonishing speed, driven primarily by the fact that almost every adult carries a cell phone (much like they carry keys) and cell phones are now PDAs as well. Faster than the adoption change from VHS to DVD in the household, we will see the average person rapidly become 100 percent schedule-connected because the value is high for all busy people, and we're all busy people now.

Trite as it may seem, the cost savings and personal productivity gains from online personal services scheduling could be enormous over time for both service providers and consumers. When your doctor's schedule is electronically connected to your personal schedule, everyone wins. The more your personal scheduler knows about your life, the better it can help you pack for the trip, alert you to your child's homework schedule, and remind you to take your medication. Oh, and don't forget the dentist appointment.