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Check vendor claims, interview references
Before implementing an automated appointment reminder system, it’s important to measure your organization’s no-show and same-day cancellation rates so you can see if the new system helps, suggests Carolyn McConnell, operations analyst for the Cleveland Clinic Foundation.
That’s the first step of a process that includes identifying issues, gathering data, selecting a solution, building a consensus, and then selecting a vendor, she says. (See tables, p. 88.) "Then there are product demonstrations, contract negotiations, time lines, and setting up a pilot. Then, there is post-implementation assessment. Otherwise, how do you know the system works?"
|Identify issues||Gather data|
|Investigate solutions||Gather data|
|Select a solution||Build consensus|
|Review products/vendors||Client referrals|
|Select a vendor||Negotiate contract|
|Set general time lines|
|Develop implementation plan||Select pilot|
|Determine rollout sequence|
|Post-implementation assessment||Does product work as anticipated?|
Selecting a Vendor
|What specific products are being used from (this vendor)?|
|What has the overall patient response been like?|
|Have any privacy-related issues come up?|
|What hidden costs have you discovered? Are your monthly maintenance fees fixed or variable?|
|Are you currently in a pilot status? If so, is scheduled rollout planned?|
|How responsive to your needs is the vendor?|
|Have there been many technical problems?|
|If there a lot of down time?|
|Are reports in a file format (downloaded) or print?|
|How do you use the reports generated from these systems?|
|Are they easy to use?|
Product Type: Appointment Reminder Calls
|Prior to installation of this system, how were appointment reminders handled?|
|What has the impact of this system been on your no-show and same-day cancel rates?|
|Is your reminder call product in use at the institution level? Or is it decentralized?|
|Do you use the "recall" feature?|
|Do you use the patient inquiry feature?|
|Has the use of this product resulted in substantial time savings for you? Greater convenience for your patients?|
|Source: Tables on this page are courtesy of the Cleveland Clinic Foundation.|
About four years ago, McConnell notes, the Cleveland Clinic began generating a quarterly mainframe production report for every department on the no-show and same-day cancellation data. So when the organization began looking for an appointment reminder system about a year ago, the information with which to make a comparison was available.
Taking the names of vendors whose systems already were in use in various foundation departments and adding a couple of new ones to the list, she and marketing manager Peter Miller started their search, she says. In addition to interviewing the five vendors on key issues (see cover story), they obtained three references for each and devised seven groups of questions for those users, McConnell says.
That wasn’t as straightforward a procedure as it sounds, she notes. "In the beginning, every one of the vendors said they had a contract with Johns Hopkins [University in Baltimore], but when questioned closely, they said the contract wasn’t signed yet. You really have to pay attention to this kind of thing."
Sometimes the vendors would say who their clients were but would not give contact names, she says. "One continually gave references to parts of their system we weren’t interested in — one that was only for prescription refills and another for checking account balances. We cut them."
The foundation was particularly interested in a vendor with a program for presenting the system to patients in a favorable light, she notes. "Many don’t have [a plan for gaining patient buy-in], so this helped us make our choice."
In the end, McConnell says, she added up the pluses and minuses for each vendor and picked the one who had the majority of features she thought necessary. Among these were good voice quality, good reports from references, and the functional capability for call blocking and two-way interfaces, she adds.
She also made sure the chosen vendor served other clients of similar size and structure to the foundation, McConnell says. Another organization, however, might be better served by a vendor that specializes in smaller operations.
Some vendors claim a 50% reduction in no-show volume with the use of their products, she notes. "I’ve seen 25% reduction personally [with systems in various foundation departments], but part of the issue is that we have different units with different delivery systems. If the patient population knows there is just one system that will call, we will have better results."
She’ll have a chance to measure those results when the Cleveland Clinic pilots its new system the last quarter of 1999, with assessment and full rollout to follow.
Even with costs of $200,000 a year, she says, an automated reminder system is an economical way to combat missed appointments. "If a machine is calling 5,000 people a day, what’s the equivalent in employees it would take to do that?"
(Editor’s note: Look for a report on the implementation of the Cleveland Clinic Foundation’s automated appointment reminder system in a future issue of Hospital Access Management.)