Smart Business Great Medicine: Care Flow

The world has changed, and the change is likely to continue. The COVID-19 pandemic is a catalyst for action, but the truth is that major changes have long been needed, like it or not. We must embrace the opportunity and create change that helps us and our patients. We must drastically improve our practice flow to survive, and much less, thrive. Scheduling systems are the heart of our practices—and they need an overhaul.

Change Is Coming

We cannot afford to squander an opportunity to radically improve our systems. Changes will happen anyway. The decision is whether or not to make those changes count. If we don’t drive meaningful change, others, well intentioned or not, will push more bureaucratic measures upon us. The epidemic of burnout will reach heretofore unimagined proportions.

Where to start? Almost everything seems to need fixing. We need to start with an area that will improve every facet of medical management, care delivery, and the business of medicine–care flow. Schedulers and the scheduling system drive care flow.

The present crisis is exposing some of the many deficiencies in our system and revealing the need for a sweeping transformation of health care delivery. For years, technology has been pushed into medicine. Often these software systems and devices were created by individuals with little or no clinical experience and then touted as THE solution. In other cases, physicians created their own systems, which often more closely address the problems in medical practice, but usually do not leverage the technology to its fullest.

As the 2020 pandemic has made clear, a moderate surge strains the system. A large influx can break it. Almost every office has been deluged with appointment cancellations, no-shows, and rescheduling. The system is not designed to handle these problems even with a full staff. What happens when the staff is decimated or halved? Once we get the schedule sorted out, we still need better methods of acquiring data, importing it into our record systems, and helping us divine its meaning.

Care Flow

Care flow, previously and simplistically thought of as office flow, has many components. Improving any of these would certainly help. From scheduling to locating the office, to check-in, to obtaining the vital signs, to check-out, to the parking lot, every facet of our practices would benefit from carefully planned optimization. Perfection isn’t vital, but improvement is. When a scheduling error occurs, the patient is typically angry, the physician’s schedule is derailed, office personnel’s stress skyrockets, and in the best case, the situation is salvaged. These problems stoke the flames of burnout leaving us planning our escape on the drive home. Reigning in the scheduling snafus will improve your outlook, the office brand, and eventually the finances. More importantly, changing the approach to scheduling can revitalize your practice. Start with scheduling. It’s certainly not glamorous. In fact, it’s a bit mundane. Most of us don’t even really think about it. It’s just supposed to happen.

A Doctor’s View of Scheduling

It is the rare physician who truly understands the scheduling process. Much more common is the belief that scheduling occurs as though by magic. A physician or other provider typically places an order in the EHR system and thinks nothing more of it until the results are posted.

Ordering something is not the same thing as effectively scheduling it. Not even close. Effective scheduling should be just as invisible and apparently simple as physicians believe it to be. Creating a system that increases the burden on the physician or creates a complicated new protocol that must be learned is doomed to failure. Similarly, transferring the mundane and repetitive scheduling tasks to the staff strains an already overburdened system but delivers little in added value.

Scheduling Reality

It seems so simple but looks can be deceiving. Scheduling is central to virtually everything we do. Office appointment scheduling is the most obvious example but that is just the tip of the iceberg. Procedures and tests must be scheduled. Telephone and telemedicine assessments need scheduling as well. There are numerous less obvious aspects of scheduling, such as prescriptions, side effect monitoring, home monitoring, and even daily lifestyle adjustment counseling.

The scheduling process for each of these elements is daunting when done correctly, and the documenting of all this information is overwhelming. Effective follow-up of each of these interactions is often an afterthought, if done at all. After working so hard to help the patient, don’t settle for second rate. We describe each component, identify pathways to improvement, and discuss the compounding rewards. There is significant variability in the quality of scheduling depending on your personnel, including the empathetic tone of the encounter.

What Should Happen

Simply put, everything that needs to happen for scheduling should happen the way physicians imagine it. It should happen as if by magic. Patient needs should be identified and integrated with provider availability and specific care needs. To be embraced, this all needs to happen with a pleasant user experience—for all involved parties.

Scheduling is difficult (Figure 1). Canceling and rescheduling a single patient encounter can take over an hour. Even with some of the add-on programs, canceling an appointment can still take 30 to 45 minutes. Some software systems can reduce this time even further but there is the risk of adversely affecting patient experience. Optimized scheduling is extremely challenging. Finding a great scheduler is hard enough. Then that individual must be available. It is a shame to waste talent handling mundane and mind-numbing duties. Free up your talented employees so they can help the practice thrive.

Talented employees earn higher salaries and can be difficult to retain. This becomes more difficult if you need several to handle the basics. Furthermore, your talented employees are still at risk of illness, especially in the face of a pandemic.

Communication

As we discussed in our last column, communication is the linchpin of success. An effective and highly integrated communication system is extremely important. Scheduling requests must come into the office with little effort and be transformed into scheduled appointments with pertinent reminders and the requisite documentation. All involved parties must be apprised of the scheduled appointment from the patient to the referring physician, to the appropriate departments. Optimizing your communications system can help this occur with limited effort.

Some new voice-assistant systems are being certified for the Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliance and use in medical practice. These are being designed to organize workflow. Voice assistants and chatbots can be added to communications systems to answer simple questions for patients such as directing people to specific areas of your website (See www.neurologysleepmedicine.com) or to help coordinate work in the clinic. These are not the old-fashioned phone trees. Those systems certainly hold promise but are not a complete answer. The answers lie in the use of the right technology with carefully optimized approaches to practice.

Voice Assistant Technology for Health Care

Voice assistants are computer programs that receive audio inputs and respond with audio output in a manner perceived as listening and “answering” questions from and by a person. A user can ask “What is the weather going to be for today?” and the voice assistant will respond with a weather report for the user’s location for that day.

The use of voice-assistant technology is becoming mainstream. Asking a voice-assisted device for information is becoming naturally integrated into daily behavior for many. The real trick is integrating this technology with both existing technologies and artificial-intelligence engines to complete specific tasks in a helpful and cost-efficient manner. Deploying technology without fully understanding the problems we face will create a host of new problems to solve.

Numerous challenges face the successful adoption of these systems by health care providers and consumers alike, but the existence of challenges should not deter us. On the contrary, this is exactly why we must pursue the goal of optimizing health care. It is important for the patient. The practice must work efficiently. If the practice loses money or, worse yet, goes bankrupt, patients will suffer along with the staff and providers.

Voice assistants are not limited to just these applications; there are many others. Together these applications and more in development may affect all individuals, workflows, and business operations in health care. Although voice technology is still in the early stage of development, it is poised to be a game-changing technology for the health care industry. According to David Box, Global Managing Director, Health and Wellness at Star, “I truly believe that voice is the new frontier. With nearly 2 billion touchless user interfaces (UIs) and internet of things (IoT) endpoints in the marketplace today, it is hard to deny that voice, as an input modality, has found a foothold in our everyday lives. This technology can help improve the patient experience as well as improve the clinical workflow.”

Seamless and Painless Scheduling

Voice has the power to transform scheduling by automating routine communications, such as routine patient phone calls, and repetitive office duties (Figure 2). VoCall is a new scheduling voice assistant, expected to be available in Fall, 2020 (www.govocall.com). VoCall interfaces seamlessly with the EHR and office communications systems.The improved efficiency reduces the need for a large scheduling staff, cuts overhead expenses, and improves the patient experience. Allowing the patient to communicate naturally on their schedule enhances the patient experience and improves patient engagement. Simultaneously, by handling the repetitive and mundane tasks, medical scheduling systems powered with voice technology free staff for more important care-centered duties.

We can no longer tolerate the status quo! Numerous software packages help perform tasks, doing business the same old way. Why not use technology to decrease work instead of creating it? We need revolutionary change not just of our software but of our approach to practice itself.

The time and money being lost to these mundane repetitive scheduling tasks is mind-boggling. A scheduler can spend over an hour scheduling 1 patient. The average cost for handling the scheduling for a single physician exceeds $75,000/year, before factoring in the technology costs. This is unacceptable.

The problem is how to instigate change. The culture of the practices must change over time. In the short-term, systems must improve finances and workflow in the background without being visible to the clinicians. With an automated scheduling system, however, having 80% of follow-up calls move from live schedulers to the automated system would provide measurable savings while improving patient satisfaction scores.