Better Quality Through Better Scheduling

By Matt Phillion

Healthcare’s relationship with technology is complicated. On the cutting edge of care, the industry often struggles with nonmedical tools and processes that other industries have already adopted. These tools, however, can be vital to improving patient engagement and decreasing barriers to effective care.

A recent report from KLAS called “Patient Perspectives on Patient Engagement Technology 2022” talks about patient, provider, and vendor alignment on patient engagement technology and which of these technologies are most desirable for the patient. Rising to the top of that list are tools that help patients schedule, register for, or check in to an appointment; refill prescriptions; communicate with a physician’s office before a visit; and find a doctor.

“The age-old adage is that healthcare is 10 years behind the times,” says Jeff Gartland, CEO of Relatient, a technology company that has developed a scheduling and communication tool for patients and providers. “It’s not all that inaccurate, but we’ve been waiting for a catalyst, those of us carrying the torch for creating a better system for patients with less administrative burden.”
Now, that catalyst—the COVID-19 pandemic and its universal impact on care delivery—has happened.

“Who knew making everything virtual for two years was the catalyst?” says Gartland. “We’ve had a monumental change, and at the end of the day it’s not that we don’t have the tech or the capability to do this, and it’s not that people don’t tacitly want more patient-centric outcomes. It’s that we have behavioral [and] change management challenges, and it’s not always easy to make those changes in a complex system.”

Technology has enabled a dramatic increase in ease and convenience for consumers, who are more comfortable than ever with digital, contactless scenarios. “We’re in a moment in time when that type of technology, the computers in our pockets, is powerful enough and capable enough that we’ve overcome some of those behavioral changes on the consumer side,” says Gartland. “People are willing to pick up their phone and engage in that way.”
Consumers are passionate for that kind of ease of access, and the industry is seeking ways to satisfy that passion. “It’s less about the basics of the technology and more how you drive that change, drive that behavioral balance of creating a fantastic, easy consumer experience while solving for all complexity for the provider downstream,” says Gartland. “That’s one of the challenges in many of the areas we work in: Often, those two sides are juxtaposed. A good consumer experience is a challenge for providers.”
For example, if a technology solution makes it easy for a patient to schedule an appointment, is it also easy for the patient to pick the wrong appointment? “When you put yourself in the shoes of the provider, all these workflows, these challenges often get compounded,” he says.

Addressing industry weak points

In recent years, healthcare communication tools have implemented a number of capabilities that consumers have long desired, such as renewing prescriptions online, viewing lab results online, or sending basic messages to their physician’s office.

“Most of these were done through portals, and over the subsequent decade we’ve learned that people don’t like portals,” says Gartland. “It’s another set of usernames and passwords. I’m a relatively healthy, middle-aged guy and I’ve ended up with five or six different portals myself for different providers, be they the dentist, primary care, pediatrician, and so on.”

The next step in the evolution of this technology is an omnichannel communication system. “Different patients have different communication preferences, so providers may need voice; sometimes it’s an email, or SMS messaging, or a chat function,” says Gartland.

The industry is moving toward what is most convenient for the consumer. A patient at work likely won’t want to have a phone conversation about their healthcare, for example. In particular, the KLAS report focuses on workflows around the need for easier scheduling.

“Scheduling sounds like a simple task: ‘How hard is it to pick an appointment? I’ve got a calendar on my phone.’ But scheduling is in fact pretty darn complex once you get past the easy stuff, like urgent care visits, where you just pick a time slot based on if the office has enough capacity to handle that number of patients at that time,” says Gartland. “When you start getting into the depths of healthcare, it gets complex. The same physician practices at multiple locations, or handles only specific procedures or needs at certain times. Just because someone’s an orthopedist doesn’t mean they do knees.”

And that’s the chief problem statement: How do care providers manage all that complexity? How many appointments can a physician stack back to back? How do they handle new versus existing patients? How do they balance patients seeking care under Medicare, Medicaid, and commercial insurance? “The needs of a new physician building up a practice are different versus a physician whose panel is chock full,” adds Gartland.

The questions and complexities keep emerging, too. Can a patient be treated by a physician extender or do they need the physician themselves? How does a practice bring care teams together? “All of these things are hugely impactful and create a complex web of rules,” says Gartland. “And that becomes the crux of the scheduling problem, determining how to adjudicate all of these rules.”

Compare healthcare, for example, to the airline industry, which has a complex system for determining how much a customer pays for which flight, managing routes, and taking into account the capacity of the departing airport versus the arriving airport. Healthcare requires that level of complexity, if not more—yet it must remain as simple as possible for the patient. “The reason scheduling becomes interesting is because of this juxtaposition—the convenience and ease of use for the consumer versus good business practices,” says Gartland.

While ease of use for patients is the most obvious talking point when discussing scheduling, making providers’ lives simpler also carries a huge underlying benefit. “Providers can have as much as 30% unused or underutilized capacity in their calendar,” says Gartland. “That’s a pretty big portion of their time not being used. And yet if you talk to consumers, the average wait time tends to be three to four weeks to see a specialist. How is that possible? It comes down to the aspect of how to match supply and demand, and tools to ease that.”

Patients are also starting to blend their view of provider performance and quality with ease of access. According to a recent Salesforce report, 60%–70% of patients rate a physician higher if that provider is more easily accessible for scheduling. “The true quality of the provider’s care has little to do with scheduling, but in the consumer’s mind, they blend those things together,” says Gartland. This juxtaposition of excess capacity against unmet demand can benefit both sides—patients can access the expert attention they need quickly, and providers who make better use of their time can increase their earning capacity.

Where do we go from here?
Currently, the EMR or practice management system is the dominant source of truth for medical information. A tool that assists with patient scheduling, engagement, and interaction can’t replace that system but instead needs to effectively layer around it. Some practices have hesitated to embrace this sort of technology, fearful of opening up that level of synchronicity to patients.

“A lot of scheduling tools simply take whatever calendar you’re using and slap a pretty, consumer-grade UX on top of it. Imagine opening up your [calendar of choice] to the entire world where anyone can book where you’re open and you don’t know the what, where, and who of that booking,” says Gartland. “This creates a lot of reasonable fear with providers.”

Giving patients too much control can exacerbate rather than fix issues with patient satisfaction. No patient will be happy to learn that they’ve booked an orthopedist for an elbow issue when that orthopedist only works on knees and hips, or that they’ve set up an appointment at a particular office on Thursday when the physician only works there from Monday to Wednesday. “That’s the biggest barrier: How do you help providers understand that there are tools and capabilities they can use and maintain control?” says Gartland.

Tools like Relatient’s Dash® platform enable that level of control to ensure that the right patient gets scheduled at the right time with the right provider. “It leverages the investments providers have made in their systems but creates a consumer layer around it, while keeping the provider’s business rules intact,” he says.

Gartland says he and his colleagues envision a world that is consolidated and oriented toward a more end-to-end workflow—where providers can leverage a single type of technology to handle various components of scheduling and patient engagement.

He notes that consumer adoption of online and virtual tools rose sharply at the onset of the pandemic and remained high. “Consumer demand for these tools is off the charts across demographics. People think the Medicare population doesn’t want these, but that’s becoming a fallacy.” Meanwhile, he says, patients under 35 years old have an almost top-to-bottom desire for this kind of convenience.

“At the end of the day, we’re passionate about creating a simpler experience, breaking down the paradigm that a great consumer experience and efficient business practices are at odds with each other,” says Gartland. “We view it as an opportunity to have an impact that supports getting patients and consumers to the doctors they need, but also drives up revenue for providers.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.