Appointments made easy: enterprise scheduling system allows New Jersey community hospital to decrease waiting times, reduce gaps between procedures and capture more registration information upfront.

Enterprise scheduling systems are designed to enhance revenue cycle management through more efficient and reliable billing, while also eliminating the organizational confusion of inadequate scheduling processes, which place great burdens on both patients and healthcare personnel. Significant efficiencies can be gained through enterprise scheduling systems by acquiring all necessary information at the first point of patient contact: scheduling. Additionally, the quality of patient care and level of satisfaction can be improved with enterprise scheduling.

Problem

Robert Wood Johnson University Hospital Hamilton (RWJUHH) is a fast-growing 200-bed community hospital in Hamilton, N.J. In 2001, we completed a two-year expansion project, which included opening a new emergency room, ICU, telemetry unit and cancer center.

These changes brought a steady growth in patients--and a correspondingly high level of patient dissatisfaction with the hospital's existing scheduling system. The central scheduling department reported average daily patient call abandonment rates as high as 29 percent, and an average of 3.5 minutes waiting time to answer a call, with waits as long as 29 minutes recorded. Attempts to schedule multiple procedures in various locations further compounded our problems. Since patient satisfaction rates consistently ranked in the 80th percentile, we were determined to move quickly to correct the scheduling deficiency.

Solution

The central scheduling department teamed with the IS department to identify precise needs and to define project goals. In July 2002, we began investigating technology solutions. After researching various healthcare scheduling technology vendors, we sent an RFP and subsequently invited two vendors to provide product demonstrations.

After a thorough review process, we signed a contract with Jacksonville, Fla.-based Tempus Software, a division of QuadraMed Corp., to implement its TempusOne enterprise scheduling system. We based our decision on a number of factors. The system's preregistration capability was very important to us, since it was an institutional goal at RWJUHH to routinely preregister 95 percent of all procedures by the end of 2003. Plus, the multiple modalities feature, which searches for the first available appointment, was a great differentiator, because it would improve our ability to schedule high-demand procedures quickly and efficiently.

In addition to the real-time access benefits, we were also impressed with the system's capabilities to improve patient access through several features, including: real-time medical necessity checking, which would enable us at the point of scheduling to automatically verify compliance for Medicare and other insurance carriers; an integrated call-back reminder system, which would allow us to set call-back reminders at the point of scheduling; and the ability to interface with existing systems by other vendors.

Implementation

The most significant aspect of the project was the compressed implementation deadline, since we thought the existing scheduling problem had a great potential to seriously affect the viability of the facility. The timeline for installation, training and implementation was set at 90 days.

An important component of the implementation was developing a bidirectional interface between the hospital's existing QuadraMed Affinity registration system and the scheduling system's preregistration component. Our analysts worked closely with Tempus staff to develop a bidirectional interface that would enable us to capture more concise and accurate preregistration data and to share this information seamlessly. Prior to our decision to implement the new system, our schedulers either had to toggle to their ADT system to preregister patients or they had to call back patients after the initial call to collect additional registration information.

The system did not require an exorbitant amount of training time. An intuitive graphical user interface and ease of product use facilitated quick learning. The rules-based design provided for natural interaction between the caller and scheduler. Within a matter of a few hours, employees were able to adapt to the system. Training for all users was completed over a six-day period.

Tempus provided on-site technical support for the installation and rollout, working with three members of the IS department. In less then three months after purchase of the system, we went live with it in March 2003 across all departments. Deployment went smoothly and quickly.

Results

Within central scheduling, we utilize the new system to schedule between 4,700 and 6,000 appointments monthly (not including physical therapy appointments), increasing outpatient volume by 5 percent compared to the prior year. With the bidirectional interface in place, call abandonment rates and waiting times have significantly decreased. Call abandonment rates are as low as 1 percent, and the average time to answer calls is between 20 and 39 seconds.

In addition to increased improved service, the scheduling system has allowed greater utilization of resources. By utilizing the multiple modalities feature, gaps between procedures are fewer, if not completely eliminated. Prior to implementation, for example, schedulers allotted one hour for an ultrasound procedure; now they schedule these procedures for 30-minute blocks. Radiology, in particular, benefits from this tighter scheduling process.

Building procedures and resources within the system was effortless. As a result, we have been able to maintain better control of our schedules. In the past, if we received a request from a doctor to block his schedule for a set period of time, we would need to submit a request to our IT staff and wait two to three weeks for them to post the change. The new system allows us to change the data in real time.

We also have improved our preregistration efficiency. Schedulers can capture critical registration and billing information at patients' initial point of contact. They can also collect diagnosis and insurance information at the same time.

Given the hospital's branding position as a champion of patient and physician satisfaction, we feel that, ultimately, ROI will be measured in terms of continued high levels of service and patient retention. If frustrated patients go elsewhere, there is no ROI. Staff response and early reporting indicate that the danger of this occurring as a result of poor patient access has decreased significantly since implementing the new scheduling system.

The hospital has plans to implement the system's callback reminder and real-time medical necessity components in the future. In addition, we hope to implement the system's real-time physician Web scheduling component, which will allow us to extend our scheduling capability off-site via the Web to our physicians' offices. Providing real-time access to our scheduling data will be a key benefit for our hospital.

Source

Lisa Breza Director of Outpatient Services Robert Wood Johnson University Hospital Hamilton Hamilton, N.J. [e-mail]

Product/Company

TempusOne Tempus Software, a Division of QuadraMed Corp. Jacksonville, Fla. www.tempus.com