Toolbox Module

Scheduling

How are patients and clinics scheduled?

The process for scheduling patients is dependent on a number of factors including the nature of the specialty itself, the acuity of the problem, the availability of facilities, the schedules of the specialists involved and the systems that are used for scheduling patients for those specialists. The purpose of scheduling is to identify a particular time and place where a specialist and a patient can be brought together for the purpose of providing health care. Telemedicine contributes an additional factor in terms of the telecommunications connections that must be used. In scheduling a live, interactive consultation, the following much be arranged:

  • Time when the provider is available
  • Room for the provider
  • Availability of the necessary equipment at the provider site
  • The secure telecommunications connection between the provider site and the remote site
  • The room for consultation at the remote site
  • The necessary equipment at the remote site
  • Time when the telemedicine presenter is available
  • Time when the patient is available

At least four approaches are available for scheduling live, interactive telemedicine consultations that accommodate different considerations. These include provider clinic scheduling, remote clinic scheduling, virtual clinic scheduling and ad hoc scheduling.

One advantage of the store-and-forward approach is that the scheduling process is much less complex and can accommodate different scheduling of the provider and patient time. The necessary information can be captured at the remote site at a time and in a place convenient to the presenter and the patient. The evaluation can take place at a later time of convenience to the specialist.

How do different types of scheduling match different specialty services?

There are two primary considerations for selecting a scheduling system: the acuity of the patient’s problem and optimization in the use of the specialist’s time. If the patient is suffering from a condition such as a stroke, severe traumatic injury or any other life-threatening condition, time is of the essence and any telemedicine consultation must be arranged on an ad hoc basis to provide prompt care for that patient. Most specialist consultations are not this urgent so there can be more flexibility in scheduling.

What is ad hoc scheduling?

Ad hoc scheduling is usually reserved for consultations that occur infrequently or which cannot be scheduled in advance. It is defined as taking place when each provider-patient encounter is scheduled individually and is typically based on the needs of the patient. Most often it is used to provide care for patients in emergency situations where the required expertise is not available locally. It may also be used for non-urgent consultations where the need is infrequent and unpredictable.

What is provider clinic scheduling?

In provider clinic scheduling, telemedicine consultations are integrated into the provider’s normal clinic process. The patients are scheduled by the remote site staff just as any other patient who visits the clinic and that time is also scheduled at the remote site. A room, which may be the physician’s office, is equipped with the necessary devices and telecommunications connections. When a telemedicine patient is next on the schedule, as the time approaches for the patient to be seen by the specialist, the remote site staff makes sure the necessary clinical information is collected and forwarded to the doctor and that the videoconferencing connection is made. The provider then reviews the patient information and then enters the room where the telemedicine equipment is located and the patient is already “present” on the monitor.

What is remote site clinic scheduling?

In remote site clinic scheduling, each remote site is allocated a block of time on a periodic basis when the specialist will see patients at that site. The remote site staff takes responsibility for scheduling local patients into the time block. The provider sees the patients one after another throughout the time block.

What is virtual clinic scheduling?

Virtual clinic scheduling is an extension of remote clinic scheduling where the provider’s time block is shared by two or more remote sites. Typically, the specialist will see a patient at one site, and then switch connections to the next site on the list while the previous site brings in a new patient and prepares them for the consultation. This is a more efficient use of the provider’s time when there are relatively small numbers of patients at the remote sites or when “no shows” are a consideration. However, virtual clinic scheduling does require more technical skill on the part of the provider and more attention from a technician at the provider’s site to switch the connections.

How are “no shows” handled?

Patients who do not appear for their appointment are a perennial problem in outpatient care and telemedicine consultations are no exception. This varies somewhat by specialty. As an example, psychiatry, psychology and dermatology tend to have higher rates than cardiology. There are two strategies for dealing with this. The first and most commonly used technique is the airline approach of overbooking appointments, or scheduling more patients for appointments in a given day than you can expect to see with the assumption that a certain percentage will not appear. The second is to put more of a burden on the remote site to make sure that patients appear for their appointments. The primary method of doing this is to execute an agreement with the remote facility that they will pay something for every scheduled visit for which the patient does not appear.

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