Overview

Direct scheduling in primary care is a tool that allows patients to book their own appointments online.

Organization Name

Massachusetts General Hospital - Outpatient Practice Improvement

Organization Type

• Academic Hospital
• Academic Medical Center
• Physician's organization

Local/Organizational Context

The innovating team were looking for ways to improve services, and they took initiative to leverage existing tools in their organization for direct scheduling, such as patient booking and Patient Gateway. The team’s priorities were to increase patient engagement with their own care, as well as improve process outcomes for practices.

Patient Population Served and Payor Information

200+ outpatient practices. Not every patient is eligible, as appointments for complicated procedures may require specific timeframes or physician approval, so the team has focused on straightforward visits, such as those in annual exams in primary care.

Leadership

Sandra Santos and Craig Cochran, both part of the MGH Outpatient Improvement team, led the initiative in direct scheduling.

Funding

N/A

Research + Planning

• Developed partnerships with different practices by contacting practices and presenting the case for the benefits of direct scheduling.
• Once a partnership is established, each practice sends out a message three times to announce the online booking system launch.
• Practice staff is given materials to market the service.
• Some practices chose to change the message on their phone line and/or website to refer patients to the new service.

Tools or Products Developed

Used Patient Gateway, an online tool for patients to interact with their health practices, for direct scheduling of appointments

Training

• Trained practice staff and managers in navigating the online booking system.

Tech Involved

• Epic
• Patient Gateway

Team Members Involved

• Administrative Assistant
• NPs
• OT
• PAs
• Primary Care Physicians
• PT

Workflow Steps

• Patients log onto Partners Patient Gateway.
• Patients can book a follow-up appointment or physical appointment within 90 days with any clinician they have previously seen. Patients pick the practice and provider and list the reason for the visit.
• Patients see the times that the practice has made available and choose an available time.
• Once confirmed, the visit is placed into the official schedule in real-time.
• The practice receives In Basket notification of the booked appointment.
• There is a two-day gap between the patient booking the appointment and scheduling the appointment, which allows the practice to review the online bookings and message the patient if needed.
• In the clinician’s schedule, online booked appointment is prefaced with “Patient Gateway”.

Budget

Budget Details

Four full time employees from the MGH Outpatient Improvement team who were already employed by MGH now spend half of their time on direct scheduling. Additional labor is supplied by a technical team and practice partners.

Where We Are

• The intervention is currently ongoing and expanding to more practices.
• The Pilot began in October 2016. May 2017 to current day has been the implementation phase.

Outcomes

• Patient Outcomes – Patients can manage their appointments through Patient Gateway. With greater familiarity with Patient Gateway, patients can use it to access test results, renew prescriptions, and engage more with their own care.
• Process Outcomes – Over 90% of primary care practices use this tool. 4,000 appointments have been booked online. The online booking no-show rate is 1.5% vs. 5% when booked by the practice. Time is saved for the practice as practices that have many patients on Patient Gateway can have up to 10% of all bookings completed online by patients. Over 50% of online bookings occur on nights and weekends when the practice is closed. Some practices have seen up to a 50% reduction in phone calls.
• Clinician or Patient Satisfaction – MGH Back Bay uses the service the most and received a 2-point increase in CG-CAHPS (patient experience) scores for two measures: “Got Urgent Care Appointment” and “Got Routine Appointment”

Future Outcomes

Expansion to more practices for more significant decreases in no-show rates

Benefits

• This intervention saves time for the practice through decreased phone calls and a decreased no-show rate.
• There is greater convenience for patients, who can schedule appointments at any time of day and become familiarized with Patient Gateway’s many advantages.
• Patients are more engaged in their care.

Unique Challenges

There was concern from practices about patients hoarding appointments. This has happened only very rarely and it can be counteracted with the built-in time for practices to review and approve bookings.

Personnel Challenges

Developing partnerships with practice requires time and effort.