Piedmont Opens Docs' Calendars for Consumer Scheduling. Physicians Embrace It.

The health system shares 4 steps to its successful initiative for do-it-yourself booking. 

As more health systems focus on enhancing consumer access, few, if any, have successfully crossed into the final frontier—enabling direct consumer access into physicians' calendars to schedule appointments.

While many offer partial access or allow patients to request an appointment, complete transparency and direct booking are rare. Overcoming physician resistance seems an insurmountable obstacle.

What happened after Atlanta-based Piedmont Healthcare traversed into this territory? Following an extensive educational process and phased rollout that is still in progress, physicians at the 11-hospital system have embraced it.

There is a waiting list of offices eager to make the transition, and 40% of patients using the online booking tool are new to the Piedmont system.

Piedmont's reputation as a physician-driven organization makes this triumph even more compelling. Insights from this experience are helpful to other health systems as the industry continues its shift toward consumer-oriented practices that have revolutionized other market sectors, but healthcare has been slow to adopt.

Overcoming the Resistance
 

Piedmont faced the same obstacles as any health system considering an open scheduling process.

"As a physician, it [felt] like the apocalypse was coming," says Jeffrey N. Haller, MD, of his initial reaction. "I was really skeptical at first, and I think that's natural. Why are we going to fix what's not broken?"

The reality of Haller's experience was much different. "It's connected me and the patient in a new and unique way," says the family practitioner who also serves as regional medical director, Piedmont Physicians-Primary Care, Central Region. "I'm benefiting through increased volume. It's filling my open slots, and that, obviously, is also translating into increased access for my patients."

Getting from point A to point B fell under the auspices of Katie Logan, vice president, patient experience, Piedmont Healthcare. She outlines four factors that led to their success.

1. Share the Consumer Philosophy
 

Piedmont has strategically embraced the concept of consumerism in healthcare.

"We want to make it easy for our customers to be able to navigate healthcare and remove as much of the burden off of them as possible," says Logan. "In doing that, we worked through a set of principles and programs that allow us to deliver on that strategic imperative."

"We worked hard to share the mission and direction across the entire organization, then to engage everyone along the way to help deliver on it," says Logan.

That effort involved presentations to multiple influential physicians and medical groups, including medical directors, committees, and clinicwide meetings.

"We shared the message about the direction of consumerism and healthcare," says Logan, "and also how Piedmont is positioned to support our physicians by making it better for our patients. Ultimately, it's better for them as well. We're fortunate we have a great group of physician leaders who see the bigger picture."

2. Listen to Your Physicians
 

Talking about the advantages of consumerism was only half of the equation. Listening to physicians' concerns was perhaps even more important in this process. "It really didn't take a negative tone," says Logan. Among the physicians' top issues:

• A fear of more cancellations or no-shows
   
• Concerns about gathering the right information before the appointment
   
• Creating inefficient operations and workflow

"We've overcome all of these concerns [and more]," says Logan.

"We've actually seen a drop in our no-show rates," says Joseph I. Miller III, MD, a cardiologist who has worked with Piedmont for 11 years. "We've found that people who make appointments online tend to show up on time and be more engaged."

Dr. Haller, who opened a practice in a new location earlier this year, says that the online booking system delivers new patients to his location, averaging about five each day.

In addition, because patients can add notes when they book appointments, Logan says that physicians report they are gaining greater context into why patients scheduled the visit, something that doesn't necessarily get communicated when appointments are booked over the phone.

Dr. Haller says that adapting to the system did change the practice's workflow a bit but did not create inefficiencies. For example, staff members now must carefully monitor appointments to ensure patients are scheduled in appropriate and timely slots, depending on their needs.

3. Create Champions
 

Logan handpicked the first physicians to test the online booking tool, selecting individuals and practice managers who were supportive of the concept. As each physician had positive results, they shared those experiences with their colleagues.

"Having physician champions really helped us," says Logan; they served as advocates among their peer groups.

As success stories were collected, Logan conducted "roadshows" with other practices who had expressed interest and began integrating the system into their operations.

4. Rollout in Phases
 

Piedmont intentionally did not roll out the program to all physicians simultaneously; Logan credits this approach as one of the key elements of its success.

The initiative began in November 2017 and is still underway. All employed physicians are now using the system and the process continues with affiliate providers.

The gradual process led to greater acceptance, Logan says. A similar method is working with same-day appointments, which physicians initially resisted. Once there were good experiences, it was instituted more broadly with primary care practices. Currently, specialists like Dr. Miller only take same-day appointments by phone.

By the Numbers
 

• About 1,600 of Piedmont's 2,000+ physicians are eligible for the online system. The remainder are hospitalists or hold positions in areas such as the emergency department.
   
• Since the November 2017 launch, 354 providers are live on the system, evenly divided between primary care and specialists, along with quick care and urgent care sites. The rollout will continue through 2019.
   
• The system averages about 2,500 online appointments a week, a number that continues to rise as more physicians are enrolled
   
• 40% of patients booking online are new to Piedmont, meaning they have never visited the system or have not made an appointment during the past three years
   
• 60% of online bookings are scheduled outside of normal office hours; 20% of those bookings occur between 10:00 p.m. and 4:00 a.m. 

Piedmont's online booking tool employs technology from Kyruus, which integrates with the health system's Epic electronic medical record.

Much Ado About Nothing
 

The most surprising aspect of instituting the online booking tools has been the lack of physician pushback.

"It's been pretty seamless, believe it or not," says Dr. Miller. "At first, there was a little noise because it involved change, but most people don't even realize now that online scheduling is happening behind the scenes. "

Logan agrees. "I'm not trying to oversimplify this, because it's big. But when physicians see some of the metrics of success, and they hear other physicians saying this works, it's really been beneficial."

As health systems transition to consumer-based practices, Dr. Haller offers another perspective. "I think a lot of us have the mindset that a program has to be physician-centric or patient-centered. Online scheduling is one example where both of those things can actually coexist."

Editor's note: Please revisit our Innovation page later this week for the tale of how two physicians adapted to direct online booking.