Patient Scheduling
Shenghui Susan Su
Myeong Kim
Barbara Hill
Zhiqiang Qian
March 16, 1998
Introduction
With the rapid development of information technology and with the growing demands for health care information, more and more health care organizations are focusing on the integrated health care information systems. The integrated health care information system, many believe, can not only better the hospital's daily operation processes in an effective and sufficient way, but also can improve its customer service to an extent that they have never achieved before. To integrate the extant information systems, organizations first need to streamline their scheduling system.
So far, many health care organizations are on the way of designing, planning, or implementing a new information system that enables the consolidation of the scheduling process. Because of its linkages between departments, sites, and settings of care, the new organizational scheduling process reveals the first glance of the challenges and complexity of "cross-continuum" care management. It provides the organizations with a new, more unified process of the organization by replacing the fragmented, local processes of the past.
Organizational scheduling system covers traditional patient scheduling, physician services, and another hospital-related schedule services including ambulatory and home care. In our project, we would like to focus on patient scheduling, the most important part of the scheduling system. We hope that, through the study of the patient scheduling system, we could provide the reader with a relatively clear picture of the health care scheduling system, its trends, and its current competitive markets. To well illustrate patient scheduling system, we would like to center on the following six sections. They are Players, Problem Statement, IT Roles, Vendor Analysis and Evaluation, Recommendation, and Conclusion.
Players
A well-developed health care scheduling system should contain the following participants:
- Clinics:
Any type of health clinics disregard of their sizes. These clinics may have physicians who are affiliated with hospitals.
- Hospitals:
These include all the local and major hospitals. They may or may not have integrated systems.
- Physicians:
Physicians are the initiator who orders certain lab testing or ask their patients to schedule for the follow check-up or examination.
- Nurses/Nurse Practitioner/Physician Assistants:
They can play direct or indirect role in patient scheduling depends on circumstance.
- Patient:
Patient can themselves request their appointment for particular testing or annual physical exams.
- Office/Clinic clerks:
They can also can take calls and make appointments for patients.
Problem Statement
Of all the activities involved in managing health care, the use of data in medical scheduling continues to take on an increasing importance. The scope of the organization ranges from physician services to all hospital-based schedules (including ambulatory and home care). It is vitally important to the operation, to obtain data from the system and use the data with other analytic tools. The ability to import and export data into other medical programs such as spreadsheets or database programs should be considered. For example organizations that receive pre-paid reimbursement, membership/enrollment and referral management is part of the health system.
Formatting can be a matter of preference for the system's ability to produce the easiest type of format for the end user. It can be very time consuming for medical personnel to finger through pages of printouts or terminal screens for raw numbers of referrals for each physician to get an idea of the patients' schedule. To efficiently manage information, the health system needs to decide which reports are needed on a routine and ad hoc basis. For example, the physician may need a monthly listing of all activity for each patient or participating physicians in the clinic. This information, if needed, could be daily, weekly, biweekly, monthly, quarterly or annually. The reports that are routing should permit the medical staff to focus on specific areas and query for further investigation. For example, watching for a trend in appointment schedules not being met could mean staff is not following procedures or more staff or specialty areas may be needed to elevate this problem. The summary of a report could send a message that the information is concise, readable, and easily interpreted. One problem could be the overkill of detail to scheduling. From the types of reports needed or pull up screens on the monitor may indicate a re-evaluation of the information needed for scheduling. It is also good to keep in mind that you get what you ask for. It is good to focus on the usefulness of the information and the amount of information revealed that necessitates needs and costs of the output.
Other concerns are the patient's inability to get an appointment, long unwarranted waits when calling the location, lack of physician locations, getting referrals, and most of all problems with quality patient care. These problems could be caused by entering incorrect identification numbers, poor responsiveness to previous inquiries, lack of documentation or training to use the system properly.
Problems that require resolution and analysis are problems that could be sporadic or random and resultantly, there may be a need to correct it. However, if the problem is widespread or stems from something that is likely to cause continual problems, then a resolution should be implemented. This resolution could mean a change in procedure, improving the training of the users, or any other events that would serve to absolve existing problems.
Automation of scheduling not only serves to help users track and manage individual problems but it also serves as a method to collect and collate data. The following are examples of production of regular reports which summarize the patients' problems or complaints:
- Automated scheduling assists in receipts needed to be logged for claims processing.
- When patients or claims are transferred to another department, they need to be noted as a referral. Receipt of the claim transfer and transaction is documented.
- Work is stored in a central location. The integrity of the files is there and assurance of not being misplaced is there.
Scheduling and medical management form the core of plan operations and control. Scheduling is where the system has a direct relationship with the patient and where all preceding relationships and information come together. Additionally, the systems rely on information created in the process of understanding and managing other aspects of the business. The quality of scheduling patients benefits administration significantly and determines the plan's overall success.
Effectiveness role of Information Technology (IT)
Ever since Watson heard Alexander Graham Bells' famous first instructions we've been racing to find better ways to convey information to more people in less time. First it was the telegraph, then the telephone, fax and e-mail. What used to take days, now takes minutes and health care has much to gain from these technological advances. Rapidly and simultaneously receiving, sending and the processing data, graphics, images, video and sound will be a mandatory requirement under health care reform. As stated in the president's health care plan - "Health plans implement and maintain core disease electronic documentation of all clinical encounters with health providers using current information system technology as the information for the system. Current information technology systems readily support the capture, retention and electronic data interchange of encounter records as a product of the provision of care with favorable benefit-cost effectiveness. This is not a fictionalized attempt to alarm the public at-large, as in the example of the chicken running through town exclaiming, "The sky is falling, the sky is falling." This is a real-life attempt by the health care industry to keep pace with rapidly evolving business and technological revolutions - it is the ability to use data.
Making the transition from paper to automated scheduling is inevitable. Implementation of information technology in clinics, hospitals and even private physician practices can provide better and faster services to their customers. This is even more effective in today's integrating service network provided by many institutions. IT in the healthcare industry is making it possible to spend less time on the paper work and spend more time on patients and providing services.
Although organizational scheduling system is only one component in the operation of healthcare facilities, it can have devastating impact on the time of service rendered to customers. More than ever people are demanding faster and reliable healthcare services. Therefore, by implementing IT into this, customer satisfaction can be achieved.
Today there are hundreds of vendors in IT industry. They provide hundreds of thousands of software packages to help health care organizations to automate their operating processes. The differences in needs and priorities in different in health care organizations imply that no single software solution fits every situation. Therefore, health care organizations need evaluate extant software packages and pick up the ones they need at a comparably lower cost.
In this dynamic healthcare environment, competition is soaring among healthcare providers. To survive in this competitive environment, organization has to use or implement the latest technology to maintain the first mover advantage. Information technology is critical to organizational scheduling systems. Healthcare Organization's need to adopt a new application for organization's scheduling process because extant legacy systems hardly support wide area network and lack compatible features. When choosing vendors, database, process, and hardware as well as financial features should be taken into consideration.
Vendors Analysis & Evaluation
The two scheduling systems we choose to analyze here are
MMS® and
TeleResults®.
MMS®
is a traditional text-based scheduling system, which is bundled within the management system. It is designed to customize each customer's needs through providing an user-friendly solution to EDI, HMO/PPO capitation processing, patient copayment messages, authorized patient services by referral number, scheduling, automatic rescheduling, prior authorization on hospital admits, automatic payment reconciling, medical records, electronic claims transmission to all carriers, managed care processing.
The TeleResults® is a modern window-based, stand-alone scheduling system. It can help perform many of the tiresome daily tasks that consume a large portion of the clinic coordinator's time. Test results, appointments, faxes, telephones - they're all handled by TeleResults®.
I. Products & Vendors
|
Product |
Medical Management System (MMS®) |
TeleResults® |
|
Product Scope |
MMS® is applied as a simple but completed health care management system, and the patient appointment scheduling system is just one part of the management system. |
TeleResults® is a scheduling system which schedules patient's clinical appointments |
|
Product Overview |
MMS® provides patient records processing system, account processing, reports generator system, electronic mail system, and scheduling system. |
TeleResults® covers the following activities: lab requisitions; test results; scheduling; voice mail; medications; prescriptions; hospital admissions; daily logs; reports. |
|
Vendors |
C&S Research Corporation
Address:
1001 West 9th Ave., Suite A
King of Prussia, PA 19406
Tel: 800-545-8460
Fax: 610-265-0786
URL: www.csrc.com
E-mail: info@csrc.com |
Medical Services, Inc.
Address:
165 Eighth Street, Suite 200
San Francisco, CA 94103
Tel: 415-621-7626
Fax: 415-621-8980
URL: www.teleresults.com
E-mail: imssfo@ix.netcom.com |
II. Customer & Participant
1. Customers
Clinics, Physician Practice Groups, hospitals, and medical centers etc.
2. Participants
Customers, Sales Representatives, Consultants, Programmers, Technical Support Clerks, Telephone Customer Service Clerks, HMO and Health Insurance Suppliers.
III. Product Analysis
- System Requirement
|
|
Medical Management System (MMS®) |
TeleResults® |
|
Operating System |
Favoring Unix as a platform for the server since it is a stable and venerable multi-user, multi-tasking system with a host of reputable vendors and suppliers. But also can run on Windows95 or NT. |
Windows95 or NT |
Microprocessor |
486 DX at least |
Pentium 90 MHz speed |
Storage |
8 MB RAM 400MB Hard Drive |
16 MB of RAM 500 MB Hard Drive |
Monitor |
VGA(SVGA recommended) |
VGA(SVGA recommended) |
Network Communication |
It can run on single PC using DOS, Client/Server environment and in enterprise networks including Windows95 Peer to Peer, Microsoft NT Server 3.5 or later, Novell Netware 3.12 or later. However, no Macintosh or IBM AS-400! |
Client/Server environment, enterprise networks including Windows 95, NT and Novell Netware. |
- System Features
- System Setup Consolidation
For MMS®,whatever system components will be determined by the customer first, then developed and integrated by the supplier; for TeleResults®,some components are defined by the user, but the software is pre-developed.
Both products are menu driven, but MMS® is text-based while TeleResults® is window-based and graphical interface. Both products have the undo function and language command, however, MMS® does not offer Help command.
|
Medical Management System (MMS®) |
TeleResults® |
|
System Functions |
Schedule, Display and Set-up functionality. Schedule functions including New Appointments, Group Cancel / open, Batch, Purge, Reschedule Cancellations, Early List, and Reptitive functions. Display functions including View Patient, List, Hardcopy, Analysis, Daily Encounters, Waiting Room, Journal. Set-up functions including Staff, Update, Presets, Comments functions |
Appointments; Reminders, Polling lab Results; Results by Phone; Customized Voicemail; Office Visits and Medication; and Custom Reports. |
|
MMS® : |
TeleResults®: |
Schedule function:
For Patient Appointment Scheduling subsystem, Grid-style and Book style scheduling interfaces are provided. Grid-style scheduling allowing the user to make daily new appointment entry according to different practitioner's schedule in a month-based interface, and the monthly maximum appointments are specified by the customer. The Book-style scheduling allowing the user to make daily appointment in a day-based interface according to different physician's schedule. For hospitals, there is Hospitals Rounds Scheduling interface which offers the user three formats of scheduling, including individual patient's detail appointment, each physician 's daily patient appointments list, and alpha listing for all daily patients appointments.
Display function:
For the Daily Encounters, it shows the Daily Encounter Form for each patient which is needed during physician's practice, including brief history , procedures needed for medical services, consultations, and confirmation of consultations.
Set-up function:
For the Staff Scheduling, it is specifically for physician scheduling. For Presets subsystem, it conveys all necessary codes for scheduling, including reason codes, department/location/specialty codes, provider codes, user initial codes, staff hours hardcopy, appointment report type selection, patient count, no appointment flags, appointment reminder card copies, batched appointment reminders, and provider codes. |
Appointments:
The clinic administrator sets up the schedules for the clinic and doctors. The patients phone in and select a time they want to visit. TeleResults® automatically checks. the schedule and sets the appointment. If the clinic is closed or the doctor is not available, TeleResults® tells the patient. It's all automatic. Patients can also cancel their appointment. A log is kept and is instantly available to show what the patient did on the phone.
Reminders:
TeleResults® will automatically phone each patient and remind them of their appointment the night before. It will then print out the results of the reminder calls, even telling you whether a person or an answering machine answered the phone! It's all automatic.
Polling Lab Results:
TeleResults® will contact your in-house lab and laboratories across the street or across the nation, automatically at the times you set. Results are merged into a common database and are available to your staff within 3 to 5 minutes. This system is in use right now - it's not a fantasy. It works under heavy clinic demands night and day.
Results by Phone:
TeleResults® will automatically fax the test results to the referring physician automatically, as soon as the test results are polled. Then, any authorized clinic staff can phone in and get the results by touch-tone phone, read back to them automatically, or faxed to any standard fax machine. No human intervention needed.
Customized Voicemail:
TeleResults® includes a voicemail system! When the patient calls in, the doctor can respond with a personal message, or the clinic staff can respond with any sort of Customized message - just click and save.
Office Visits and Medication
But TeleResults® does even more. TeleResults® maintains each patient's medication record, alerts for contraindicated drugs and drug interactions, and issues prescriptions. It captures disorders, procedures and vital signs for each office visit. A dose card can be printed to advise the patient how and when to take the medicines.
Custom Reports
TeleResults® has its own selection of over 59 reports, but you can also generate any kind of report with an add-on reporting tool. Any kind of report. You use TeleResults® in your clinic the way you see fit. Then create the reports you want. |
For the Staff Scheduling, it is specifically for physician scheduling. For Presets subsystem, it conveys all necessary codes for scheduling, including reason codes, department/location/specialty codes, provider codes, user initial codes, staff hours hardcopy, appointment report type selection, patient count, no appointment flags, appointment reminder card copies, batched appointment reminders, and provider codes.
MMS®
has two major reports, Accounting and Management reports, which are including totally 47 reports; but the user can generate other report as user's need during the set-up consolidation phase. However, MMS® does not support any image add-in , image processing, or storage functions.
TeleResults® has its own selection of over 59 reports, also the user can generate any kind of report with an add-on reporting tool. TeleResults® supports basic image add-in, image processing, or storage functions.
MMS®
provides relational database function. The user can lock or unlock some specific records, or make read/write or read-only records. It also provides simultaneous access cabability.
TeleResults® also provides relational database but with graphical interface, however, besides lock/unlock, or read/write functions; it also provides comprehensive filter function to serve multiple queries.
MMS®
does not offer database protection, such as password authorization; however, TeleResults® has security restrictions, allowing access only to those that have need. Each module has three levels of security which can be assigned independently to any user, no access, read only, and read/write.
|
Medical Management System (MMS®) |
TeleResults® |
Free Training Program |
Yes |
Yes |
Consultation |
Yes |
Yes |
User Manual |
Yes |
Yes |
1-800 phone service |
Yes |
Yes |
24-7 Technical Support |
Yes |
|
Web Inquiry Service |
Yes |
No |
No cost information available for MMS®.
Total Budget for TeleResults® is $8900 when the system adopted in one workstation environment, and $950 for each additional workstation.
IV. Product & Work Practice
- How The System Performed and Integrated
|
Medical Management System (MMS®) |
TeleResults® |
|
How The System Performed and Integrated |
This software is not a "one size fits all" solution, but is designed from the group up with the concept that according to the customer's unique requests and operations. So that all features cane be modified as several ways described as follows:
- The software is completely preset-driven. This means that you can achieve considerable control over the software's operation through presets either by the vendor or by customer.
- The software is developed after comprehensive consultation between customers and vendors through the sales process and the implementation phase.
- The Global Switch feature allowing the user to turn on or turn off to active/deactivate some features.
- Modular in design providing "prefix" modules to override "generic" modules, so that customers can easily preserve their system across upgrades.
|
Schedule patient appointments; Telephone patients with appointment reminders; Talk to patients in English or Spanish, switching automatically; Poll labs in-house or across the country; Combine all lab results into a common database for easy reports and graphs; Send your test results by fax and voice to doctors and patients according to the user's selection. |
- The Relevant Managerial Issue
- Labor and time saving in scheduling patient appointments
- Work flow efficiency improvement
- Reducing errors occurred due to circumstances in manual scheduling and fragmented information
- Automatic error detection by means of Reminder
- Customer's Feedback
|
|
Medical Management System (MMS®) |
TeleResults® |
|
Customer's Feedback |
The Saint Barnabas Outpatient Centers:
Location: Livingston, NJ
Total Acute-care Beds: 620
Daily Outpatient Visits: 548
Daily Inpatient Visits: 105
Daily Emergency patients: 9
Response:
Very good features, effective functions, and extremely helpful in the customized statement generating package; exceptionally responsive from the vendor such as came in over the weekend to install and provide on-site technical support..... |
UCSF Kidney Transplant Clinic:
Location: San Francisco, CA
Response:
The system benefits the staff to keep tracking doctors and scheduling patients appointments with a phone call at any time of day; automatically calls patients the day before with a recorded reminder; another feature of the system heartily welcomed by doctors is the automatic warning notice when human scheduling errors occurred. |
V. System Performance & Evaluation
1. Vendor Rating
|
Criterion: |
Vendor |
|
Medical Management System (MMS®)
Patient Appointment Scheduling
|
TeleResults®
Patient Clinical Appointment Scheduling
|
|
Five Scale Rating: --------- 1 (bad) --------- 2 (poor) --------- 3 (fair) --------- 4 (good) --------- 5 (excellent) ------ |
|
Hardware & Operating System: |
|
Operating System Compatibility
(If the system can run on all platforms, rated as 5 scale; otherwise, dropped one scale for not capable O/S) |
4 |
3 |
Workstation Compatibility
(If the system supports all workstations, rated as 5 scale; otherwise, dropped one scale for not capable workstation) |
4 |
4 |
Network Communication |
4 |
4 |
| Reports: |
Report Format |
4 |
5 |
|
Generating Reports From Variety Perspectives |
5 |
5 |
|
Two Scale Rating: 0 - No , 1 - Yes |
| Scheduling Modeling: |
Daily Patient Appointment Scheduling |
1 |
1 |
Monthly Patient Appointment Scheduling |
1 |
1 |
Scheduling With Authorized Visit Tracking |
1 |
1 |
Calendar Preferencing Scheduling |
0 |
1 |
Searching the Next Time Slot |
1 |
1 |
Reminder Function |
1 |
1 |
Automatic Alerts to Any Special Circumstances |
0 |
1 |
Voice/Fax Technology Integration |
0 |
1 |
| System Integration With Existing Patient: |
Management System |
1 |
0 |
On-line Scheduling Capability |
0 |
0 |
| Graphics: |
Image Support |
0 |
1 |
Image Processing |
0 |
1 |
Image Storage |
0 |
1 |
| User Friendliness: |
Graphic User Interface |
0 |
1 |
Menu Driven |
1 |
1 |
Language Command |
1 |
1 |
Help Command |
0 |
1 |
Undo Functions |
0 |
1 |
| Data Management: |
Relational Database |
1 |
1 |
Data Filtering Feature |
0 |
1 |
Database Security |
0 |
1 |
Simultaneous Access |
1 |
1 |
Customized Database |
0 |
0 |
| Vendor Support: |
Training Program |
1 |
1 |
Consultation |
1 |
1 |
User Manuel |
1 |
1 |
1-800 Phone Service |
1 |
1 |
24-7 Technical Support |
1 |
0 |
Web Inquiry Service |
1 |
0 |
| Cost Factors: |
Total Budget Amount/Numbers of Users |
N/A |
N/A |
Leveraged Payment |
N/A |
N/A |
Maintenance Cost |
N/A |
N/A |
|
Total Rating |
33 |
45 |
2. Pros & Cons
|
|
Medical Management System (MMS®) |
TeleResults® |
|
Advantages |
- Capable for major platforms
- Tailored to customer's needs
- Ease of use for maximum efficiency
- Bundled inside the management system removing the integration problems
|
- Window based interface
- User defined set-up features
- Support image processing and storage
- Voice/Fax Technology integration
- Automatic Alert feature
- Comprehensive Filter Function
|
|
Disadvantages |
- No graphic Interface
- Not support image processing and storage
- Lack of Calendar preferecing interface.
- Lack of customized database
- Lack of on-line scheduling feature
|
- Not support Unix or DOS
- Lack Web Inquiry Service
- Foreseen problems in system integration
- Lack of customized database
- Lack on-line scheduling feature
|
Recommendation
Our analysis and evaluation of extant products reveal that the following features are critical to the success of the healthcare scheduling systems.
- Operating System: Capable for major platforms, such as DOS, Unix, Windows 95 or NT.
- User Friendliness:
- Window based,
- Graphic User Interface
- Tailored to customer's needs
- Scheduling Modeling: Calendar preferencing interface, automatic alert on error scheduling, system integration with current systems, on-line scheduling feature and voice/fax technology add-in.
- Graphics: Support image processing and storage.
- Reports: Variety reports generating from many perspectives of users.
- Data Management: Provide data filtering function and customized database.
- System Security: User authorization and database protection.
- Vendor Support: Web & PC Inquiry Service.
Conclusion
IT explosion and managed care are the two major drivers for the current change of healthcare information systems. Many organizations are taking advantage of this opportunity to reengineer their information systems. Patient Scheduling, presented in our paper, is a case in point to illustrate such a change. In order to fully utilize the scheduling system, the above-mentioned recommendations should be taken into consideration.
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Appendix
List of relevant vendors for patient scheduling:
- C & S Research Corporation
- Clinical Networx, Inc.
- Datamedic Corporation
- Electronic Healthcare Systems, Inc.
- Epic Systems Corporation
- Experior Corporation
- Healthcare Automation
- Healthcare Media Enterprises, Inc.
- National Data Corporation
- PDM Productive Data Management, Inc.
- Pen Rad
- Physician Micro Systems, Inc.
- R & L Software Associates, Inc.
- Surgical Information Systems, Inc.
- Tempus Software, Inc.
- TeleResults
- Unibased Systems Architecture, Inc.
- Atwork
- Consort Technologies
- Health Data Sciences
- Nuesoft Technologies, Inc.
- Integrated Medical Networks
Go back to the Project Page
Rema Padman, rpadman@andrew.cmu.edu