Cheap, ubiquitous teleconferencing technology can turn any visit to a primary care provider into a patient-centered care team huddle, cutting weeks off the referral run-around and reining in costs. But it only works if the right team of providers, specialists, and the patient are available at an agreed-upon time.
Every one of us carries in our pocket or bag one of the untapped technological saviors of healthcare.
No, it's not Twitter. It's the calendar on your phone.
It's one of those things that generally goes unused, but not because it wouldn't be extremely useful. It's because schedule-sharing for years has had a "last mile" problem, an interoperability chasm.
Because of this gap, patients still receive phone calls or emails from providers to remind them of upcoming appointments. Phone calls may be ignored or dumped into voice mail with a dozen other messages which people are too busy to check. Emails can wind up in spam folders. Appointments entered onto some online patient portal may as well be listed on the far side of the moon.
Is it any wonder that despite the best efforts of providers, the healthcare system is continually burdened by missed appointments that leave exam rooms and equipment tied up with no-shows?
This is a problem that must be addressed soon and in a big way. Care may be decentralized, but it must be coordinated.
The waste and inefficiencies of missed appointments is bad enough in private practices. But now we are entering the age of the e-consultation, where large systems such as Intermountain Healthcare plan to turn most every encounter into a telemedicine encounter. Cheap, ubiquitous teleconferencing technology can now turn any visit to a primary care provider into a patient-centered care team huddle cutting weeks off the referral run-around.
But it only works if the right team of specialists, the PCP, and the patient are available at an agreed-upon time. All the broadband bandwidth in the U.S. won't matter if a specialist or a physician can't see her free and busy times at a glance and quickly coordinate with others on the team. Patients, too, need to see all their appointments at a glance, instead of scrolling through email or listening to recorded calls ad nauseam.
Big, proprietary solution providers such as Epic are offering their own solutions, but woe to the patient who has a provider or six outside one of those systems. And woe to large physician practices with a hodgepodge of EHR vendors to support.
And yet, I am optimistic that solutions are at hand for the diverse IT needs of healthcare.
The most recent evidence I have found comes from the U.S. Department of Veterans, which just completed its Medical Appointment Scheduling System (MASS) Contest.
All the winning entries work with the VistA open-source EHR software used by the VA, and are themselves open source, which will perk up the ears of foreign countries whose entire EHR infrastructures are built upon VistA.
The winning team's entry, Health eTime, is working code that can set individual, group, and patient appointments, with a ton of features that form the basis for all sorts of intriguing resource utilization analytics. I saw a brief demo, and marveled at Health eTime's capabilities. Care coordinators are truly project managers with the ability to schedule and re-schedule sequenced appointments and appointment-dependent tests, assisted by Health eTime.
As to providing physicians and patients with unified glances at their schedules, Health eTime supports the CalDAV standard*, a way for calendars on smartphones and tablets to receive automatically "pushed" updates to their calendars reflecting moved, added and changed appointments. Those subscriptions, unlike ordinary emails, are securely delivered. And they don't just wind up in someone's voice mail or e-mail inbox. (Although I note with dismay that CalDAV support is spotty on Windows phones and some Android phones, iPhones and iPads support CalDAV beautifully.)
Health eTime's patient portal also can be populated from VistA to serve up directories of providers. Once a patient chooses a provider, Health eTime can display that provider's free and busy time slots.
Just think how many phone calls and emails that could save the VA. Dare I say patients would be happier? Staff no longer needed to schedule all those appointments by phone could be put to far better use in delivering care.
By structuring this as a contest, the VA avoided the usual soul-crushing process of issuing a request for proposal (RFP), usually the start of a mind-numbing blizzard of bureaucracy that, too often, lead to Web sites such as healthcare.gov.
The price to the U.S. taxpayer for all this scheduling goodness came out to a bit more than $3 million, which also includes three other top winning entries. In return for the cash, the teams delivered their source code to OSEHRA, the Open Source Electronic Health Record Agent, which publishes the VistA code under an open source license.
The VA hopes to implement an updated scheduling system based on this winning code within 18 months, starting with a pilot at a smaller hospital, says Michael L. Davies MD, national director of systems redesign at the VA.
"Integrating with VistA is not a chip shot," Davies says. "It's hard, in part, because industry has to understand what the [scheduling] problem is. The other piece of it is that not all of our VistA code is documented in a way that allows industry to come in and just plug into it."
With 70,000 personnel VA currently scheduling more than 85 million appointments a year, the potential cost savings are huge. I don't know how many appointments the rest of healthcare schedules annually, but I can't help thinking it's a number that dwarfs 85 million.
In this column, I've only scratched the surface of the possible efficiencies of scheduling technologies. It's a topic I intend to return to. As the Internet of Things emerges, we will see more and more ways for technology to insert itself appropriately into the ultimate workflow – that between providers and patients. The possibilities appear endless.
* Full disclosure: I am so enamored of scheduling's potential, I currently serve on the Board of Directors of CalConnect, the Calendaring and Scheduling Consortium, a non-profit organization that champions the CalDAV standard, and which serves as the nexus for the IT industry to move this work forward. I invite you to check them out.
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.