Two doctors whose calendars were opened love the result.
When Piedmont Healthcare in Atlanta launched a new online scheduling system, enabling consumers to directly book appointments into physicians' calendars, the system was prepared for pushback from the medical staff.
A robust education campaign and slow rollout, with physician champions leading the way, resulted in a surprising outcome: physicians have embraced the concept, and there is now a waiting list to enroll.
Many health systems are hesitant to break this barrier, not wanting to impose another change on physicians, particularly at a time when they feel overburdened by administrative responsibilities. I spoke to two physicians employed by Piedmont about their concerns, their experience, and how they adapted to the new system, which offers complete visibility and access into their schedules.
While their initial reactions were very different, they both are now avid fans. A glimpse into their experience may be helpful as other hospital systems prepare to offer open booking to their own consumers.
2 Physicians, 2 Perspectives
I spoke with:
- Jeffrey N. Haller, MD, a family practitioner who's been with Piedmont for 15 years and also serves as regional medical director for Piedmont Physicians-Primary Care's Central Region; and
- Joseph I. Miller III, MD, a cardiologist, who has worked with Piedmont for 11 years.
When he first heard about the online scheduling concept Piedmont was proposing, Haller somewhat jokingly characterized his initial reaction as the "apocalypse" coming.
Miller's reaction was much different. "I actually thought if you can schedule your car or hair appointments online, from a patient access and hospital operating standpoint, scheduling physician appointments online was a win-win."
Physician Concerns: Real and Imagined
Miller was an early proponent of online scheduling. When talking to colleagues who raised objections, he pointed out that if they had the convenience of booking airline tickets themselves, why should booking an appointment with a physician be any different?
Haller has the answer: "There are a lot of considerations that your average person doesn't think about." New patients take longer than established ones. Urgent cases should take priority and be given immediate appointments, while patients with emergencies need to be directed elsewhere.
"There are real concerns about what can go wrong, as well as imagined concerns," says Haller, who articulates many of the fears the medical staff expressed when Piedmont introduced the concept.
As a family practitioner, Haller wants to know if patients are coming in for a physical exam, a wellness visit, a quick check-up, or something longer.
"What if somebody we're not familiar with has a multitude of medical problems? That's a very real concern," Haller says. "Am I going to get overwhelmed with patients scheduling short visits who [need] long visits? That was probably one of the most realistic concerns. And what if I have a patient scheduling themselves a week out for a relatively urgent problem? Do we have a safety feature to say this person probably needs to be seen earlier?"
While Miller was supportive of the online scheduling system, as a cardiologist, he also had apprehensions. "If somebody's having chest pain," he says, "we don't want them [scheduling an appointment] online. We want them to either go to the emergency room or speak to a nurse." Another concern: a potential spike in patients who didn't show up for appointments.
System Delivers Unexpected Benefits
So while they had some trepidation, both physicians were willing to test the system. Both were surprised to discover it delivers tremendous advantages to their practices.
"It didn't have the tremendous negative impact that I was concerned about," says Haller. In fact, it had the opposite effect. "It's been a positive experience for me," he says. He credits the system with helping to build his patient base when he and his practice partner transferred to a new location earlier this year. In fact, Piedmont says 40% of appointments booked through the system are from new patients.
"We have a lot of openings," says Haller. The online booking system is directly responsible for filling about five appointments per day. "Instead of seeing 15 patients a day with 10 open slots, I'm seeing 20 patients a day with five open slots. [The system] really enhances the growth of Piedmont's new practices and clinics."
Rather than creating a huge disruption, the transition was similar to the launch of any other technology initiative, Haller says.
"Every time we change or create a new system, there are always some challenges and adjustments," Haller says, "but I just haven't seen the bad fallout that we were really concerned about."
Miller also was pleased that his fears never materialized. "We've actually seen a drop in our no-show rates," he says. He also finds patients using the online booking tools are more proactive and engaged in their healthcare. While he doesn't have an explanation for the phenomenon, he guesses that it's attracting savvy consumers.
Measures built into the system address one of his other concerns. For example, if the patient indicates they are experiencing chest pain, they are automatically redirected to call the office or visit the emergency room. And, at least for now, online schedulers cannot get a same-day appointment with the cardiologist; they have to speak with someone first to rule out emergent situations.
Schedule Woes Never Materialized
Prior to rollout, one of the primary concerns physicians expressed was the ability to appropriately schedule patients. To their surprise, it's become a non-issue. The family practitioner and specialist have devised different solutions. New patients visiting Miller, the cardiologist, are automatically booked into 30-minute appointments; returning patients are booked into 15-minute slots. "It's worked out pretty well," he says.
Haller reconfigured the appointment book and now offers all patients 20-minute appointments, an example other physicians are following. "I created a happy medium. There is no long or short [option] anymore. I lose a little bit of time on some visits, and I gain time on others. It just seems to equal out as the day goes on."
Meeting Consumer Needs
Both physicians see merit in making the healthcare experience more consumer friendly and understand that the new online scheduling system offers a significant step in that direction.
"Our consumers are demanding increasing convenience and new ways to access [our services]. I think we need to deliver that," says Haller. "I don't think adding another way for our patients to connect with physicians is ever a bad thing; I'll try just about anything, especially if it will enhance our patients' experience."
Miller says that the concept of consumerism is not as foreign to physicians as one might think.
"We're consumers too, right?" he says. "We're very aware that we have to be flexible and adaptable. Part of our success in the past is that [Piedmont] is physician-led. It will still be that way into the future, but we need to be aware of consumers' needs.
"To be competitive," Miller continues, "we have to maximize our efficiencies, and be open to new approaches and technologies. We're just on the forefront of this whole consumer-driven care [initiative]. The more we can do to improve it, is huge. If we don't do it, we're going to get left behind."
Mandy Roth is the innovations editor at HealthLeaders.