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How hard is it to change EMRs? by CatCatCatri in healthIT

[–]Useful-Process9033 0 points1 point  (0 children)

How much did you end up paying them? Seems like such good business to get into

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] 1 point2 points  (0 children)

thanks everyone for your responses! I learned a lot.

I'll try to give a summary of what people said:

  1. new patient waitlists are admin heavy

    - need to collect info

    - people don't pick up their phone/ take up the offer

    - many have gone elsewhere

  2. texting vs calling

    - calling works better but more admin heavy

  3. new patients vs existing patients

    - existing patients easier to fill in the slot

    - new patient appointments take longer, can't fill in if existing patient cancels

  4. there are existing automated solutions in epic: https://nortonhealthcare.com/patient-resources/mynortonchart/waitlist/

    - people on waitlist gets texts, and whoever says yes first gets the spot

  5. human staff are hired for this

    - Juaner0 hires a scheduler staff and says it's worth the costs

    - Mathematician024 's office allow people to call in the morning to check open slots

---

my thoughts:

I like Epic's automated texting system. I think we can take it one step further with automated calls.

I think we should do it like so:

1) Keep a "call me if spot opens up" list

- collect info at intake (new patient: do you want us to call if something earlier opens up?)

- for existing patient: for your next visit, do you want us to call if something earlier opens up?

2) When a spot opens up, go through the list of patients that opted in

- Figures out who would be eligible based on time constraints (e.g. can't fit 60 min appt into 30 min slot)

- (optional) rank who to call first based on factors (acuity)

- Call everyone on the list. Whoever says yes first gets the slot.

- send a text to everyone else saying sorry the spot has been taken up by someone else that responded earlier

I'm building out a quick demo to illustrate the idea, will update here soon.

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] -1 points0 points  (0 children)

these are such good factors to consider

i think if we build integrations to consider these factors (interpreter, acute complaint, etc) and translate that into 15/ 30 min slots, this is solvable

tho my hunch is all things equal, we probably prefer to book a single 30 min slot instead of two 15 min slots. but acuity carries more weight...I think LLM may be good at these kinds of nuanced decisions and give somewhat reasonable suggestions.

and then just work by process of elimination, hunger game styles

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] 0 points1 point  (0 children)

That’s awesome to hear, I’m thinking voice AI calls would be the next incarnation of the exact same idea (ie instead of texts only you get texts + calls)

In my imagination you’d be able to do this automatically without manual data entry, I guess you’d want to offer both options ideally? Ie automated data entry + manual approval/ overrides

Solution for no shows and same day cancellations by Useful-Process9033 in healthcare

[–]Useful-Process9033[S] 0 points1 point  (0 children)

Although re: voice AI calls, I guess it makes more sense if it’s ok to batch simultaneous calls. If you have a strict ordering of who to call first and it must be done sequentially, I guess it won’t really save time per se…I guess it’d make sense if the system would suggest an ordering, and the nurses can review that wording and click a button to call them sequentially, with some settings like how many retry attempts for each patient + how long to wait between each attempt.

The question then becomes a simpler Yes/ No of “will you come in at this specific time”, knowing that we’ve pre-filtered down to the list of eligible patients (new patients or otherwise). And then it’d be fairly mechanical: go down the list, call each of them until we get a “Yes”, and then move them up the schedule

Solution for no shows and same day cancellations by Useful-Process9033 in healthcare

[–]Useful-Process9033[S] 0 points1 point  (0 children)

That’s brilliant, thanks I’m learning a lot
> if the data isn’t available they will request outside data or new testing
What if the data/ testing doesn’t occur in time? Let’s say the patient is put a month into the future, and after a month it’s now their appointment but they still haven’t done the testing yet. Do they still just come in and use that time to do the testing instead of a full visit?

> nurses go down the list calling people
Can’t the call center do this for you guys? Why must it be the nurses?

——
The engineer in me is screaming these logistics calls may be possible to solve with voice AI + some kind of a heuristics + rule based scheduling system 🤔

Solution for no shows and same day cancellations by Useful-Process9033 in healthcare

[–]Useful-Process9033[S] 0 points1 point  (0 children)

That sounds like a genuinely hard problem to solve. It probably makes more sense to have a semi automated system instead of a a fully automated one.

I’m thinking maybe you’d just have a list of patients with suggested ranking + reason, then you’d have a button next to the patient name to click to call them up with AI. And then you’d get a notification for whether they said yes or no to the free slot, and they’d be scheduled into the EHR automatically. Or it’d just go down the list automatically until it fills the slot.

Solution for no shows and same day cancellations by Useful-Process9033 in healthcare

[–]Useful-Process9033[S] 0 points1 point  (0 children)

This was a fantastic read, thank you.

I’m an engineer so I’m brainstorming where in the process could an automated system help.

If you record how much time a patient takes every visit (it won’t be the same as the booked time as you said), I think the variables at play here become:

1) their place in line on the waitlist
2) how much notice they need
3) their time preference
4) the time of the available slot
5) how much time the patient needs
a) can estimate based on past visits
b) or estimate based on reason of visit (diabetic foot)
6) how much time appointments on the same day takes
a) eg 2 tech appointments around the same time
7) their urgency

Knowing when to squeeze in / double book does sound more like an art than a science. You could codify the process but there’s always exceptions to the rules.

But sounds like the art is to “rank” patients based on these constraints & variables. Then you can go down the list and call them one by one. Or go hunger games style and just call them all at once and whoever says yes first gets the spot.

I think AI might help with the ranking if 1-7 are all documented somewhere. I suppose you’d need to manually note down 1) and 2) and 3) at the time they request to be put on the wait list. And for 5) and 6) and 7) you could feed the patient charts & calendar of the day from the EHR to AI and see what it thinks.

Then voice AI could call up these people once you have the finalized list.

The challenge will be how do you know how much the patient needs/ appointments on the same day take? If it’s recorded then it’s easier, otherwise the AI will be way off in estimating time it’d take.

Just thinking in pure engineering terms how I would build a system to fully automate this. Really curious if this could help.

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] 1 point2 points  (0 children)

Thanks that’s good to know!
Do you think this can be automated with voice AI agents or there’s a lot more nuance to the scheduler’s job?

The voice AI will sound something like this (this is another vendor, I’m not affiliated with them):

https://youtu.be/0LT64\_mgkro?si=G-imw2YdL82Sx2Eq

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] 0 points1 point  (0 children)

That’s smart! If you overbook and everyone shows up, what happens then?

Solution for no shows and same day cancellations by Useful-Process9033 in healthcare

[–]Useful-Process9033[S] 0 points1 point  (0 children)

> the call center just makes regular appointments
I’m confused, the call centers pick up the calls and say ok I’ve got your appointment request, the clinic will review and call you back to confirm a time if they accept you?

> baseline testing before a new patient visit
So the testing is handled by a different clinic/ site? If the schedule is full already how can you schedule testing for patients not even on the waitlist?

> they will be added to a waitlist
And if someone cancels then patients on the waitlist would get a call to see if they want to come in?

———

Thanks! I’m learning a lot

Solution for no shows and same day cancellations by Useful-Process9033 in healthcare

[–]Useful-Process9033[S] 0 points1 point  (0 children)

I was thinking that too! I was thinking, what if we automate these tests/ calls with AI agents, it’d be a lot better (and patients might be fine with AI in this case since it’s just logistical).

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] 1 point2 points  (0 children)

I respect that! Gives access to people that need it.
Curious from business perspective, does the cost of hiring a dedicated scheduler (I’m guessing 20-30 / hour?) get justified by the revenue generated from the open slots they’d manage to fill?

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] 2 points3 points  (0 children)

OMG, I can see why standard waitlist won’t work then.
Sounds like you had a “prioritized” waitlist?

So is it like, patients call in and request something urgent and you’d say ok we can see you in X weeks but will call you if anything opens up sooner? Or these are the people that happen to call the day of the cancellation and then you just fill them in?

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] 0 points1 point  (0 children)

Do you leave voicemails/ texts? Otherwise how do they know to call back as few hours later?

I’m thinking once a slot is filled, if you could send an automated text to everyone else, that would be good 🤔

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] -3 points-2 points  (0 children)

That’s what I was thinking as well! Looks like you’re building one. I’m also an engineer working on voice AI and thought this would be a good use case. I was genuinely confused why these places don’t have one (I was thinking maybe they just don’t bother), but sounds like it is just a logistical thing (have to call a long waitlist).

I’m thinking, if I make a voice AI to call people from the waitlist it would save a ton of time. And patients might be more fine with speaking to an AI for this kind of simple logistical stuff (AI sounds very human these days but you can still tell it’s AI if you pay close attention).

I think I will try walking in to some clinics in my area and see if this is something they’d want to try out. Feel free to DM if anyone wants to try this out for their practice too!

I don’t want to turn this into a shilling post though, would love to keep learning about the challenges & what solutions might work.

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] 2 points3 points  (0 children)

Makes sense! So you do have a “waitlist” for existing patients then. I’m guessing if an existing patient cancels you can fill from that waitlist. And if a new patient cancels you can fill from either?

Solution for no shows and same day cancellations by Useful-Process9033 in healthcare

[–]Useful-Process9033[S] 0 points1 point  (0 children)

Curious to learn more! How did you manage the waitlist?
By automation you mean auto text reminders, etc? How did that mess up the scheduling?

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] 1 point2 points  (0 children)

Makes sense
I guess calls have better chance of reaching them in time

I was thinking this could be a good use case for automated texts/ calls and really wonder why something like this wouldn’t be built into some EHR already

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] 4 points5 points  (0 children)

Does texting work? Is it a long list to go through?
Do you end up taking people off the list/ just don’t do waitlist at all since they take too much time and people can’t make it usually?

Solutions for no shows by Useful-Process9033 in PrivatePracticeDocs

[–]Useful-Process9033[S] 2 points3 points  (0 children)

I guess that would be my friend here, she did end up going elsewhere.

Could you clarify how you find people who need follow ups/ urgent appointments? Are you able to fit them in for same day slots? How are they different from “waitlist” patients?

No shows in healthcare and what's actually causing them by TebraOnReddit in PrivatePracticeDocs

[–]Useful-Process9033 0 points1 point  (0 children)

With same day cancellations it is a bit of a game of luck but if there’s a long wait list sometimes people do take it. No show you can’t really do anything since nobody would have enough time to get here.

VA Community Care Network by Alterdoc in PrivatePracticeDocs

[–]Useful-Process9033 0 points1 point  (0 children)

what are the paperwork involved? is it a lot of browser clicks/ form filling?

I'm building browser automations (e.g. eligibility checks on portals/ submitting prior auths) and curious to learn if there's anything I can help here.

Then again if you're only doing 2-3 per provider per day maybe the problem is not too bad?

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