Implementing an automated calling system to reduce ENT appointment no-shows

¶ … Strategic Planning Document

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PLANNING MODULE I - PREPARING for HIMS STRATEGY DESIGN and PLANNING

REVIEW HIMS ASSESSMENT RESULTS

STEP 2 - REVIEW HEALTH SYSTEM DEVELOPMENT PRIORITIES and DEFINE

HIMS PROBLEMS

STEP 3 - INVENTORY of on-GOING HIMS STRENGTHENING EFFORTS

PLANNING MODULE II - HIMS STRATEGIC PLANNING

STEP 4 - PRIORITY HIMS COMPONENTS and PROBLEMS

STEP 5 - the HIMS VISION

STEP 6 - CURRENT and PLANNED HIMS STRENGTHENING EFFORTS

STEP 7 - HIMS OBJECTIVES and INTERVENTIONS

STEP 8 - INTERVENTION IMPLEMENTATION PHASING

PLANNING MODULE III - DETAILED HIMS PLANNING and COSTING

STEP 9 - DETAILED STRATEGY DESIGN and ACTIVITY IMPLEMENTATION

PLANNING

STEP 10 - HIMS STRATEGY COSTING

STEP 11 - HIMS STRATEGY MONITORING and EVALUATION (M&E)

STEP 12 - the HIMS STRATEGIC PLAN DOCUMENT

Executive Summary

This study generally follows the step-by-step procedures set forth in the Guidance for the Health Information Systems (HIS) Strategic Planning Process developed by the World Health Organization to facilitate the implementation of a new calling system for an ear, nose and threat (ENT) department of a tertiary healthcare facility. The need for this system is immediate and significant. In the past, an inordinately high percentage of patients have failed to keep their appointments with the ENT department, resulting in lost time and resources as well as less than timely medical care. The focus of this study was to develop an automated calling system that notifies patients concerning their upcoming appointments in an effort to reduce the number of missed appointments. A description concerning the preparatory steps involved in the initiative and an analysis concerning how the initiative will be implemented is followed by a description of how it will be implemented, monitored and evaluated to determine its effectiveness and identify opportunities for improvement.

PLANNING MODULE I - PREPARING for HIMS STRATEGY DESIGN and PLANNING

STEP 1 - REVIEW HIMS ASSESSMENT RESULTS

The preparation team will evaluate the system to meet the needs of the three locations for the Otolaryngology Department (hereinafter alternatively "the ENT department") in question. An analysis of the appointment data for the past year indicates that fully 60% of all patients miss their appointment due to the scheduling time that is involved. This high percentage level is in sharp contrast to the national average of about 5% (Weiss, 2008) and represents a significant drain on already scarce healthcare resources.

One of the reasons for this inordinately high level of missed appointments is believed to be the lengthy time required for scheduling follow-up appointments from time to time. The normal scheduling time will always be at least 30 days or longer if the department is shorthanded and this lengthy period between appointments is believed to contribute to the unacceptable level of missed appointment. To help address this problem, an electronic calling system can help notify patients concerning upcoming appointments to confirm them, a process that is expected to result in more patients showing up for their appointments on time. The health information management system (HIMS) assessment for this step consists of a questionnaire for the patients to complete upon their arrival for their scheduled appointments (see proforma copy at Appendix a). The team will use key questions to evaluate the scope and extent of the problem in order to formulate informed interventions that can reduce missed appointments and facilitate coordination of patient care with other healthcare providers.

STEP 3 - INVENTORY of on-GOING HIMS STRENGTHENING EFFORTS

The next step in the Guidance for the Health Information Systems (HIS) Strategic Planning Process is to inventory on-going HIMS strengthening efforts within the tertiary healthcare facility in general and the ENT department in particular. For this purpose, Cyr and his associates recommend the following steps should be followed in developing an assessment of current departmental strengths and weaknesses.

1.

Review the ENT department to establish or determine its principal service functions.

2.

Describe the principal functions and processes of the service/unit:

a.

Who are the suppliers?

b.

Who are the customers for the services?

c.

What are the linkages among suppliers, providers, and customers?

d.

What services or service areas are high risk, high volume, or problem-prone?

3.

Establish service and performance expectations to meet professional and institutional standards.

a.

What do suppliers, providers, and customers expect of one another?

b.

What short- and long-term goals need to be developed to meet and exceed those expectations?

STEP 4 - PRIORITY HIMS COMPONENTS and PROBLEMS

The implementation of the automated calling system will require the acquisition of a suitable system as well as its installation, training of the personnel tasked with its operation and ongoing maintenance to include updating patient contact data.

STEP 5 - the HIMS VISION

The vision of the initiative envisioned herein is to reduce the missed appointment levels in the ENT department from 60% to the national average of about 5% within one year.

STEP 6 - CURRENT and PLANNED HIMS STRENGTHENING EFFORTS

At present, there are no plans to alter the medical center's primary healthcare management information system; however, the automated calling system selected for this initiative does not require any special modifications for its installation and implementation; however, the automated calling system selected will be required to be compatible with the hospital's HIMS for the purposes of uploading patient contact information as discussed further below.

STEP 7 - HIMS OBJECTIVES and INTERVENTIONS

The general objective of the automated calling system initiative envisioned herein is to improve the overall quality of patient care delivered by the ENT department by reducing the percentage of missed appointments as follows:

1. To reduce the percentage of missed appointments to 40% within 3 months.

2. To reduce the percentage of missed appointments to 20% within 6 months.

3. To reduce the percentage of missed appointments to 10% within 9 months.

4. To reduce the percentage of missed appoints to 5% within 12 months.

STEP 8 - INTERVENTION IMPLEMENTATION PHASING

The initial implementation of the automated calling system will require a significant amount of data entry concerning patient contact data; however, this data can be integrated in digital form from existing healthcare information management system as discussed further below.

PLANNING MODULE III - DETAILED HIMS PLANNING and COSTING

Although the actual acquisition of the automated calling system selected for this initiative will be completed by the hospital's purchasing department, a preliminary review of available representative systems that meet the needs of the ENT department is provided in Table 1 below.

Table 1

Representative Automated Calling Systems and Specifications

Vendor

Description

Comments

Voicent

(http://www.voicent.com/)

BroadcastByPhone: Automated dialing software can reach people by phone or by voice mail with personalized messages the auto-dialer uses a computer to deliver personal calls or leave answering machine messages in a human voice or a computer-generated voice. Calls are delivered either through a VOIP channel, such as SIP or Skype, or through regular phone lines.

Once purchased, there are no additional monthly or per-call fees to pay. Product features include live-call transfer, automated messages, touch-tone opt-out options and an easy-to-use, Excel-like interface. In addition, this product features:

1. Save/restore call list, import or copy-paste call list.

2. Detects human pick up, answering machine, busy, no answer, disconnected line.

3. Automatic retry for busy line or no answer

4. Built in calendar for advanced call scheduling.

5. Daily, weekly, monthly, and yearly recurring calls.

6. Call until confirm (for emergency alert escalation).

7. Automatically schedule call for next day if calls are not finished.

8. Multilingual Text-to-Speech (optional) for customizing each phone call.

Call-Em-All

(http://www.call-em-all.com)

This product features voice broadcasting and text messaging technology.

Month-by-month plans are available or users can opt for a "pay-per-call" basis.

All setup is accomplished online.

Features of this product also include:

1. Calls can be made online via VOIP or directly from landline phones.

2. Record message via the vendor's toll free number or upload user-created audio.

3. Text messages and audio messages can be combined in a single broadcast.

4. Uploading patient contact data is simplified.

Voice Broadcast

(http://www.callfire.com)

This product features:

1. Ease-of-use allows message recording and uploading phone lists and scheduling times and dates for outbound messages.

2. Speeds of over 50 calls-per-minute (increased speeds available by request).

3. No contracts.

Other useful features include:

1. Ability to schedule for specific times.

2. Answering machine detection.

3. Different messages for machines and people

STEP 9 - DETAILED STRATEGY DESIGN and ACTIVITY IMPLEMENTATION PLANNING

The strategy design for the initiative envisioned herein will proceed in a step-wise fashion as set forth below:

1. Analyze the results of the administration of the questionnaire (see proforma copy at Appendix a) to identify the extent and scope of the missed appointment problem that represents the focus of this initiative.

2. Communicate the goals and requirements of the automated calling system initiative to all of the stakeholders (especially the chiefs of information and resource management and purchasing) to solicit feedback and identify unexpected constraints to implementation;

3. Conduct cost analyses to identify the optimal choice of automated calling systems for the purposes of the ENT department.

4. Acquire automated calling system.

5. Coordinate integration of patient contact data with hospital's information and resource management (IRM) department.

6. Begin outbound calls to remind patients of upcoming appointments using the data developed from the administration of the questionnaire (if applicable).

7. Regularly evaluate the effectiveness of the automated call initiative as described in Step 11 below.

STEP 10 - HIMS STRATEGY COSTING

The costs of the automated call initiative envisioned herein extend beyond the initial acquisition and installation of the system and will include the time required for training ENT departmental personnel concerning its use (this will be an on-going need for new staff members assigned this responsibility). There is also the question whether to purchase an automated calling system that requires a contract, a pay-per-call payment or a one-time purchase. Based on the available products reviewed in Table 1 above, the superior approach would appear to be the BroadcastByPhone product offered by Voicent. Not only does this product have a number of desirable features that make it suitable for the purposes of the ENT department including a user-friendly interface, it provides a number of useful analytical reports that can be used to evaluate the effectiveness of the automated calling system as described further below.

STEP 11 - HIMS STRATEGY MONITORING and EVALUATION (M&E)

Monitoring and evaluating the effectiveness of the initiative is an essential element in its successful implementation and administration. For this purpose, Cyr et al. (1999) recommend that healthcare organizations follow the steps below:

1. Develop logical indicators to monitor the quality of the services provided. Pay particular attention to the linkages among suppliers, providers, and customers, and to indicators for high risk, high volume, and problem-prone service areas.

2. Develop and test thresholds for the indicators chosen, using both internal analysis and benchmarking methods as appropriate. Decide how frequently to carry out the environmental scan for each indicator.

3. When first setting up the model, the ENT department may want to focus on developing indicators for only one or two principal functions or processes. Alternatively, the ENT department may find it more useful to focus on finding one or two good indicators for several principal functions or processes.