Schedules should be designed to accommodate the types of appointments and mix of patients needed to attain clinician, practice, and department goals, including patient access and practice revenue.
Cadence, the Epic scheduling tool, supports scheduling with Templates (weekly schedules that define clinicians’ availability) and scheduling functionality. It’s important to understand how staff are using Cadence – if it is meeting goals, and the specific types of scheduling that are easy or are time-consuming or difficult to use.
Used in conjunction with other Cadence functionalities (e.g., blocks, sessions limits/minimums), Auto Search can quickly and easily locate available time for a visit type you are scheduling, including recently opened slots due to cancellations.
General Cadence access does not allow the user to make significant changes to templates; Template Builder enables the user to build and edit templates. Schedulers and template builders should make updates per the department’s schedule change policy.
Order-Based Scheduling/Patient Self-Scheduling
Order-based scheduling is an exciting new hospital-wide initiative that will help us improve patient safety, reduce administrative and clinician burden, and optimize the patient experience. Order-based scheduling is made up of three key components: schedulable orders, smarter scheduling, and patient self-scheduling.
- Schedulable orders indicate which clinician the patient needs to see for follow-up, within what timeframe. Once a scheduler or clinician places an order for a follow-up visit, it is immediately recorded in Epic and will appear on the workqueue once the Expected Date is within 60 days. The patient can then self-schedule the appointment in Patient Gateway.
- With smarter scheduling, we contact the patient within 60 days of the desired appointment date. This decreases the chances a patient will cancel or reschedule and reduces churn-related administrative burden.
- Having begun in spring 2021 with a single follow-up visit type and straightforward visits that do not require coordination only, over time we will increase patient self-scheduling functionality to include all planned follow-up visits. If the patient is not enrolled in Patient Gateway, the practice will call the patient to schedule their follow-up appointment. Their order will also be in the workqueue to prevent loss to follow-up.
Scroll down to “Tools and Resources” on this page for links to tip sheets and resources pertaining to order-based scheduling/patient self-scheduling.
Recalls
Recalls enable practices to monitor patients who need to schedule a future appointment. Annual and physical visit types automatically generate a Recall, and schedulers can manually set up a Recall. When a Recall is entered in Epic, the Recall displays on the patient’s Appointment Desk and on the Recall Report. Appointments can be made directly from a Recall, which makes the scheduling process more efficient. See the Creating Recalls Tip Sheet.
Wait List
Wait List increases schedule utilization by inserting patients on a Wait List into cancelled appointment slots. Wait List usage is a prerequisite to using FastPass functionality.
Wait List positively impacts practices in several ways:
- When patients are entered into Wait List, filling cancelled appointments is easier.
- At time of cancellation, the system prompts the scheduler to review patients on the Wait List.
- All insurance referrals related to the future appointment are added to the new appointment.
FastPass
FastPass notifies patients on a Wait List of open appointment times when there is a cancellation on the clinician’s schedule; it allows the patient to schedule directly. FastPass keeps clinician schedules full and reduces front desk workload. It also gives patients more control over their care.
FastPass functionality:
- A patient is added to the Wait List.
- An Auto Wait List Batch Job runs at 5 pm daily, identifies available appointment slots that match Wait List patients with similar appointment criteria, and identifies up to five patients to fill each slot.
- Patient Gateway automatically messages the patients on the report with offers to accept the available appointment.
- If a patient accepts the offer, the appointment is scheduled; if this patient had a scheduled appointment at a later date, it is cancelled.
- Once a patient accepts the appointment, offers to other patients expire.
- At 8:00 the following morning, all offers expire.
- If a slot remains available, an offer will be sent to the next set of matching patients when the batch runs again at 5 pm that day.
See the Fast Pass Tip Sheet.
- Ensure all scheduling staff are properly trained, including on how to:
- Use Auto Search
- Schedule appointments in a clinician’s multiple locations
- Schedule an appointment with a clinician and a resource
- Implement scheduling workflows according to documented standards, including:
- Direct scheduling, which requires:
- Development and adherence to standardized templates
- A standardized approach to review In Basket messages that indicate an appointment was booked (to ensure the patient has an appropriate appointment and the system is working as designed)
- Recalls
- Implement the Recall feature for any appointments over 90 days
- Wait List
- FastPass
- Direct scheduling, which requires:
- Document the process for making schedule changes and which staff have access to make those changes in Epic.
- Identify barriers to meeting scheduling goals.
- Make Auto Search the standard for all scheduling. Identify and adjust any barriers to using Auto Search:
- Determine if search results are appropriate for the visit you are scheduling.
- Document instances when results are not accurate and consider Cadence tools that could help.
- Consider if double booking is appropriate for your practice; double booking helps mitigate the impact of no-shows but can contribute to long waits if both patients arrive.
General
The following Blueprint pages provide more information and resources related to scheduling:
- Epic Cadence Template Optimization
- Insurance and Authorizations
- New Patient Access
- Pre-Appointment Activities
- Referral Management
Order-Based Scheduling/Patient Self-Scheduling (OBPSS)
- Overviews:
- Order-Based Scheduling FAQs for Administrative Staff (new!)
- Order-Based Scheduling FAQs for Clinicians (new!)
- Order-Based Scheduling Overview (.pptx format; will open in PowerPoint)
- MGH Ambulatory Order-Based Scheduling and Patient Self-Scheduling Introduction and Overview (video)
- Template readiness:
- OBPSS Template Readiness Review Guide
- Adding and Adjusting Slots Tip Sheet
- Adding Unavailable Time Tip Sheet
- Updating Visit Type Limits Tip Sheet
- OBPSS Template Readiness Webinar (video of 4/30/21 session)
- OBPSS Template Readiness Webinar slides (.pptx format; will open in PowerPoint)
- OBPSS Template Readiness Q&A
- Order-based scheduling Epic tips:
- Order-Based Ticket Scheduling Tip Sheet for Admins (updated 10/18/21)
- Order-Based Ticket Scheduling Tip Sheet for Clinicians (updated 10/18/21)
- Creating a Custom Workqueue (WQ) Filter
- How to Link an Appointment to an Order After It Has Been Scheduled
- Customize Your Preference List for Efficient Ordering (new!)
- How to Transfer a Follow Up Order from One Workqueue to Another Workqueue (new!)
- How to Personalize Your Side Bar to Include the Follow Up Orders Report (new!)
- Extending, Discontinuing, and Editing Orders (new!)
- Order-Based Scheduling Check-Out Script
- OBPSS Patient Gateway Tip Sheet (revised 8/27/21) – shows the patient side of the self-scheduling process, completed via Patient Gateway
- Follow Up Order Change Request Form – use to request follow up order changes for practices partnered with Ambulatory Capacity Management