A woman named Jane calls into the central call center of a health system. She is sitting with her 90-year-old mother in front of the seventh floor elevator of one of the hospital’s clinics. “We have one hour of downtime between my mother’s second and third appointments. She’s in a walker, so it’s hard for her to move around. Can you help me figure out how long it will take me to get from here to the next appointment location, and which way we should go to avoid stairs?” she asks. “And is there any chance the doctor could see her now so I can get her home before her dinner?”

Unfortunately, this scenario is not uncommon. Patients with complex diagnoses, comorbidities, or undergoing complex procedures are often required to schedule multiple appointments that need to occur within a reasonably tight window of time – and sometimes in a specific order. But the appointments are not always arranged with the patient’s convenience or logistics in mind. It could be a laboratory test that needs to happen before the office visit or three multidisciplinary physicians who must see the patient before determining her treatment course. It could also just be someone and their family members wanting to coordinate visits so that they can all make a single trip to the medical center campus without having to wait too long between appointments.

Graham Gardner

Only a handful of the leading medical facilities in the country are equipped to do this type of coordinated scheduling. In fact, mainstream practices and systems in healthcare scheduling do not make it easy to book these types of “linked appointments” in any sort of coordinated way, let alone in a manner that takes patient convenience and preference into account.

Itinerary-based scheduling is the concept of booking a well-coordinated set of appointments in a manner that accounts for clinical protocols (e.g., respects the required order of appointments and pre-visit requirements), patient convenience (e.g., optimizes for contiguous times in the same location), and availability of appropriate resources (e.g., ensures that a technician is available to operate the equipment being used during a patient’s evaluation, immediately followed by a consult by an attending physician).

A substantial portion of the nearly 600 million specialist visits that occur every year in the US could benefit from a more coordinated, itinerary-based scheduling approach. What could Jane’s mother’s experience have looked like if the hospital she was visiting had an itinerary-based approach to scheduling care?

Coordination of multiple appointments

 Let’s say Jane’s mother was suspected of having a heart rhythm disorder. Based on her medical history and current status, standard care protocols may suggest that she receive an electrocardiogram, a blood test, and a Holter monitor placement, followed by a monitor read out session three days later.

Legacy scheduling systems require that the person scheduling those appointments book each individual one separately, and then manually determine whether the time and locations of each appointment will be practical for the patient. Even this scenario is only possible if the organization has a centralized scheduling function; otherwise, each appointment is scheduled locally within each practice, which adds an additional layer of overhead for the patient.

An itinerary-based scheduling system could:

• Have a pre-loaded or configurable “linked appointment set” protocol that automatically knows which appointments should be scheduled together for a given diagnosis or care plan.
• Be able to dynamically assemble a set of appointment slots that respects the protocol’s sequencing, spacing, and duration requirements, while optimizing for shortest time, distance, and accessibility options between appointments.

This approach could have saved Jane and her mother from having to wait too long between her three appointments for this particular visit, as well as any subsequent visits required by her care protocol. For instance, she could also have had her follow-up visit scheduled ahead of time so that she was guaranteed to be able to get into the clinic in a timely manner after the Holter monitor evaluation period.

Personalized instructions & directions

 If you’ve ever been to a destination wedding, you know that in addition to the schedule itself, there is a significant amount of ancillary information provided to guests, whether it be pre-registration instructions for entertainment options, or driving directions to and from each venue.

Julie Yoo

The same applies to clinical appointments – each visit in a linked appointment set may have pre-visit instructions that the patient needs to follow, such as taking a shower before a Holter monitor placement, since the device needs to stay dry for the duration of the study. The path between visit locations may be non-trivial, so the patient might benefit from simple visuals or instructions for navigating the medical center campus. Typically those instructions are provided to the patient over the phone; a text-based email or snail mail packet might be sent ahead of the visit as well, but often the patient is left to her own devices.

A modern itinerary-based scheduling system would:

• Ensure that the patient received timely reminders for pre-visit requirements to enable patients to prepare appropriately and maximize compliance.
• Provide the patient with simple, easy-to-understand navigation instructions personalized to her specific itinerary (perhaps even via a live wayfinding application the patient could use while walking around the campus).
• Acknowledge any special accessibility and transportation preferences of the patient. For example, if she were driving to the medical center, the instructions would be tailored to include directions to the parking lot closest to her first appointment.

Jane’s mom would have also received information accounting for her walker to make the travel between appointments as short and accessible as possible. At a minimum, this personalized information could help to reduce the level of stress for the patient, who is already likely experiencing anxiety due to her medical condition.

Multi-resource coordination

Many disease states and procedures require the coordination of multiple clinical resources, whether human or non-human. For instance, an initial diagnostic visit to a cancer center might involve a set of visits with a medical oncologist, radiologist, and surgical oncologist, as well as multiple tests administered by a nurse using special equipment.

Sometimes there are logistical issues to coordinate, such as the availability of a technician to operate a specific machine, or simply the patient’s physical requirements. For Jane’s mom, she likely had to change into a gown for her electrocardiogram as well as the Holter monitor fitting; instead of changing twice and visiting a lab for a blood draw in between, perhaps she could have been seen in the same consult room by two different clinicians.

Itinerary-based scheduling could:

• Automate the process of coordination between multiple schedules of multiple resources to reduce operational complexity, human error, and reliance on real-time human judgement when looking across multiple scheduling systems.
• Maximize the yield from the time the patient spends on campus, by ensuring completion of as many multi-disciplinary visits as possible during the trip.

Dynamic itinerary-based scheduling approaches have the potential to have impact along a number of dimensions – with benefits for both patients and the healthcare organizations providing their care:

• Patient experience – more streamlined appointments, easier-to-follow instructions, and a productive and convenient time visiting the hospital or clinic.
• Health system operational efficiency – less reliance on human schedulers to coordinate across complex appointment scheduling in a manual fashion.
• Provider capacity optimization – better utilization of multidisciplinary resources that may reside in different scheduling systems.

With advances in technology, there’s no reason itinerary-based scheduling should remain limited to a small set of institutions in the US. Right now there are people like Jane and her mother across the country seeking a better patient access experience. Itinerary-based scheduling can go a long way in helping health systems deliver it to them.

Dr. Graham Gardner is CEO, Kyruus  and Julie Yoo is Kyruus chief product officer. Boston-based Kyruus develops provider search, scheduling, and data management tools and services that help health systems match patients with the right providers, enhance patient access across entry points and optimize provider utilization.