Impact of Web-Based Self-Scheduling on Finalization of Well-Child Appointments in a Primary Care Setting: Retrospective Comparison Study (Preprint)

Abstract

BACKGROUND Online booking of flights, hotels, and sports events has become commonplace in the travel and entertainment industry, but online self-scheduling of healthcare appointments is not yet widely used. An electronic health record (EHR) that integrates appointment scheduling and patient online access to medical records creates an opportunity for patient self-scheduling. Mayo Clinic developed and implemented a feature in its Patient Online Services (POS) web and mobile platform that allows software managed self-scheduling of well-child visits. OBJECTIVE We examined the use of a new self-scheduling appointment feature within POS in both web and mobile formats and determined use characteristics, outcomes, and efficiency of self-scheduling compared to staff-scheduling. METHODS Within a primary care setting, we collected 13 months of all appointment activity for the well-child visit for children ages 2 through 12. As these specific appointment types are for minors, self-scheduling is performed by parents or other proxies. We compared the appointment actions of scheduling and canceling for both the self-scheduled and staff-scheduled appointments. The frequency that patients were using self-scheduling outside of normal business hours was quantified and we compared ‘no-show’ outcomes of finalized appointments. RESULTS Of 1099 patients who performed any self-scheduling actions, 73.1% (803/1099) exclusively used the self-scheduling and self-canceling software. For those with access to self-scheduling (patients registered to Mayo Clinic POS), 4.92% (1201/24,417) of all well-child appointment scheduling actions were self-scheduled. Staff-scheduling required more than a single appointment step (e.g., schedule, cancel, reschedule) in 28.32% (3729/13,168) compared with only 7.01% (53/712) of self-scheduled appointments (P < .0001). Self-scheduling appointment actions took place outside of regular business hours 29.5% of the time (354/1201). No-shows accounted for 3.07% (28/912) of the self-scheduled finalized appointments compared to 4.12% (693/16,828) of staff-scheduled, a non-significant difference at P =.112. Staff-scheduled finalized appointments (that allowed for appointments greater than 12 weeks in the future) revealed a potential demand of 11.15% (1876/16,828) for appointments with longer lead times. CONCLUSIONS Self-scheduling can generate a significant number of finalized appointments, decreasing the need for staff scheduler time. About 30% of self-scheduling activity took place outside of usual staff scheduler hours, adding convenience value to the scheduling process. Over 90% of exclusive self-schedulers created a finalized appointment with a single appointment scheduling step. No-show rates were not adversely impacted by self-scheduling.