# Presentation: 385690

## RSA support for ACA

- Peter Woodbridge, MD
- ACOS, Ambulatory Care
- Indianapolis, IN VAMC

## Key Features

- GUI
- Appointment purposes
- Resource management
- Pending lists / waiting lists / recall lists
- Linked visits
- Group visits
- Patient preferences
- Inter-facility scheduling

## Biggest Changes

- No more “Clinics”
- Clinics are organized into “services”
- Appointments are made by purpose
- Providers are resources
- No more “slot” management
- Appointment types have assigned durations
- Time, not slots, managed by provider availability

## Advanced Access #1:Work down the backlog

- Current reality
- Difficult to find un-booked openings across clinics as clinics have one appointment type
- Workaround
- Manually search many clinics
- New scheduling package
- A clinic represents a service type (e.g., neurology); a provider is a resource
- Search “services” across multiple provider openings

## Advanced Access #1:Work down the backlog

- Current reality
- Can not differentiate new patients from return as there is only one appointment type per clinic
- Workaround
- Carve out certain times of the day for new patients
- New scheduling package
- Differentiate new patients from return (“appointment purposes”)

## Advanced Access #1:Work down the backlog

- Current reality
- Patients stay in specialty clinics as there is no way to enforce return to primary care guidelines
- Workaround
- Manually identify chronic stable patients and discharge to primary care
- New scheduling package
- Flag patients with multiple visits to a specialty clinic

## Advanced Access #1:Work down the backlog

- Current reality
- Unable to create additional appointment slots without modifying clinic grid
- Workaround
- Give staff “mega overbook” key
- Unintended consequence – loss of control
- New scheduling package
- Restrict overbook key to specific services

## Advanced Access #2:Reduce demand

- Current reality
- Patients are scheduled for routine follow up to avoid loss to follow up (future appointments as reminders)
- Workaround
- Manual follow up lists
- Reminder cards
- New scheduling package
- Long-term pending lists

## Advanced Access #2:Reduce demand

- Current reality
- Patients have duplicate future appointments in same clinic
- Workaround
- DHCP report that identifies duplicates *(local report)*; manual review and editing
- New scheduling package
- Pop-up asking for confirmation on attempt to book second appointment

## Advanced Access #2:Reduce demand

- Current reality
- Clinic appointments are fixed length
- Complex patients are brought back to clinic to complete workup
- Workaround:
- Book two, back to back, appointment slots
- New Scheduling Software:
- Create longer appointments on the fly to do today’s work today

## Advanced Access #2:Reduce demand

- Current reality
- Difficult to manage recurring, group visits
- Workaround:
- Each patient must be scheduled, checked-in, and checked-out individually
- New Scheduling Software:
- Group scheduling module

## Advanced Access #2:Reduce demand

- Current reality
- No-support for patient self-management
- Workaround:
- Patients walk-in
- New Scheduling Software:
- Support for web-scheduling

## Advanced Access #3:Understand supply and demand

- Current reality
- Inadequate outcome and process measuring tools
- Work around
- KLF reports
- Fileman reports
- New scheduling package
- Process and resource management tools
- Real demand data (by services provided)

## Advanced Access #3:Understand supply and demand

- Current reality
- No report to determine provider capacity (supply) based on past and future appointments
- Work around
- Manually collate data from multiple sources
- New scheduling package
- Advanced access capacity report

## Advanced Access #3:Understand supply and demand

- Current reality
- High no show rates
- “Catch 22” – tied to no method for tracking patients not on schedule
- Workaround
- Overbooks
- Manual no-show lists
- New scheduling package
- Pending lists
- Multiple no-show patients are flagged

## Advanced Access #3:Understand supply and demand

- Current reality
- High no show rates
- Patients are scheduled at clinic’s convenience
- Work around
- Modify check-out involve patient in scheduling
- New scheduling package
- Patient preferences

## Advanced Access # 4a:Reduce appointment types

***Work around for current system limitations***
- Major Paradigm shift
- “Clinics” vs. appointment types
- e.g., Headache clinic vs. headache appointment in Neurology Clinic
- Manage by time vs. slots
- Use services (appointment purposes) to manage workload and track data (e.g., new patients)
- Let demand determine number of type and number of services to fill work day

## Advanced Access # 4b:Standardize appointment lengths

***Work around for current system limitations***
- Major Paradigm shift
- To stay on schedule, make appointment length match complexity
- Then, manage by time, not slots

## Advanced Access #5:Plan for contingencies

- Current reality
- System does not differentiate patient from provider cancellations
- Work around
- Manual tracking
- New scheduling package
- Track clinic cancellation reasons to enforce policies

## Advanced Access #5:Plan for contingencies

- Current reality
- Auto-rebook cancelled clinics to reduce risk of loss to follow up
- Work around
- Require chart review and manual rebooking before rescheduling
- New scheduling package
- Automatically put patient on pending list

## Advanced Access #5:Plan for contingencies

- Current reality
- Patients given future appointments even when it is known that a resident is to rotate off service
- Patients are rescheduled when new resident schedule is identified
- Work around
- Place patient on manual recall list until new resident schedule has been identified
- New scheduling package
- Put patients on pending list

## Advanced Access #6:Manage the constraint

- Current reality
- Insufficient time stamps to identify process constraints
- Work around
- Manual time-motion studies
- New scheduling package
- Time stamp milestones as patient moves through clinic

## Advanced Access #7:Optimize care team

- Current reality
- No resource coordination capabilities
- Staff is waiting around in case they are needed
- Work around
- Manual resource coordination
- New scheduling package
- True resource scheduling

## Advanced Access #8:Synchronize patient, provider, information

- Current reality
- Synchronize first appointment of session
- Workaround
- Scheduling logs for equipment and rooms
- New scheduling package
- True resource management: providers, staff, equipment, rooms

## Advanced Access #9:Predict and anticipate patient needs at time of appointment

- Current reality
- Patients visits to the medical center are not coordinated
- Workaround
- Manually verify that patient completed prerequisite procedures and testing and reschedule if not completed
- New scheduling package
- Linked visits

## Advanced Access #9:Predict and anticipate patient needs at time of appointment

- Current reality
- Patients make visits to Medical Center more frequently than necessary
- Workaround
- Manually look for future appointments to any clinic before scheduling
- New scheduling package
- Visit aggregation

## Advanced Access # 10:Optimize rooms and equipment

- Current reality
- No support for resource management
- Workaround
- Use manual scheduling for resource managements
- New scheduling package
- True resource management