Epic Cadence Template Optimization

Templates are the regular, weekly schedules that define when clinicians are available (and unavailable) to see patients. Well-designed schedules are essential to maximizing capacity, ensuring patient access to appointments, and maximizing revenue for the practice. Cadence is the Epic scheduling tool; it supports scheduling using templates and advanced scheduling functionality.

Advanced functions (e.g., Auto Search, Wait Lists, Recalls) drive efficiency to improve the scheduling experience for both patients and front-line staff. Best practices of scheduling templates ensure accurate performance reporting and better analytics capabilities to solve business problems.

Cadence template optimization positively impacts practices in several ways; it:

  • Reduces the need for schedulers to remember the scheduling nuances specific to each department and clinician
  • Reduces scheduling errors
  • Provides accurate tracking of visit types
  • Improves clinic flow by scheduling appointments in the proper slot
  • Reduces call handling times
  • Efficiently presents scheduler with all available options (e.g., across clinicians, locations, departments)
  • Improves template slot utilization
  • Enables tighter management of specific visit types (by limiting or expanding availability based on practice goals/needs), particularly for urgent visits and new patients
  • Allows for easier identification of high no-show populations and types of unutilized slots

Types of Schedules

There are three main types of schedule builds for clinicians.  Each type has pros and cons; you may find that different types of schedule builds will work for different clinicians, based on your practice.

Schedule Tips
Blocks for visit types are needed to save room for patients Use time release to release if not used close to date of service. These visits should also be allowed into unblocked time.
Blocks that are tied to multiple resources and must occur at a specific time Use time release to release the slot to a different and more inclusive block.
Overscheduling of visit types Use visit type limits to prevent overscheduling of visit types.

The schedule is wide open – no time is reserved for any visit type. Any visit type can go anywhere on the schedule.

Goal for open access schedule: Increase the number of new patients that are seen.

Concerns with open access scheduling:

  • Split slots
  • Patients take longer – could make the clinic run late
  • Visit lengths could be different from slotted lengths
  • No appointments for acute care
  • Anything can be scheduled with that clinician
  • The clinician could have a whole day of new patients
  • Not able to reserve time for urgent visits
  • Overlapping appointments
  • Unable to maintain scheduling expectations and guidelines
  • Not having enough time to cover specific visit types
  • Patients could be waiting too long to be seen and end up going elsewhere
  • Schedule can get filled up with visits scheduled far in advance
  • Urgent visits may not be able to be scheduled quickly
  • Clinicians may not be able to control the number of specific visit types they see in a day
  • More chance of overbooking clinicians
  • Shorter slots are all that are available and longer appointments can’t fit

Every slot is blocked for a particular visit type or type of patient.

Goal for prescriptive scheduling: Increase the number of visit types or type of patients that are seen.

Concerns with prescriptive scheduling:

  • Specific visit types must be scheduled at specific times
  • Time may go unused
  • The schedule is too restrictive and doesn’t allow for flexibility
  • Access is prohibited
  • Possible long wait times
  • Patient visit types don’t match – which would lead to unused slots
  • Limits accessibility
  • Users override schedule to make certain visits work
  • Patients are not satisfied
  • More touches per encounter to get an appointment scheduled

Balanced scheduling is an open access foundation with blocks to preserve supply for short-notice visits and blocks, limits and rules for more complex situations. This is a mix of prescriptive scheduling and open access scheduling. This type of schedule is the preferred build.

  • Determine if data exists to impact what percentage of the schedule should be blocked for specific visit types or types of patients.
  • Evaluate supply and demand of visit types on a regular basis to make sure these match up.

Balanced scheduling allows protected time on the clinician’s schedule to see particular visit types, but also leaves some time on the schedule for patients who need to be seen urgently during unblocked time.

Practices are expected to build templates according to these documented standards, which apply to all departments. Any exceptions must be documented, including the reason, approved by the section chief/medical director, and sent to the Practice Improvement Division for review.

Practice managers and/or template managers should be familiar with the following Cadence basic template constructs:

  • Panels: Use to schedule two or more visits simultaneously.
  • Advanced search to pool the needed resources into one search.
  • Provider Rules: Rules in a Cadence provider template to accommodate specific preferences.
  • Scheduling Rules: Quick alerts to message the scheduler.
  • Scheduling Warnings: Visual cues to inform schedulers of possible slots that require more attention.
  • Session Limits: Sessions can be defined to allow a certain number of visit types per session.
  • Groups of providers who share a common trait or care team.
  • Functionality to pull in a group of providers.
  • Time Release Block and Change: Visit type blocks can change to another block or unblocked slot a certain number of times before the appointment date.
  • Visit Blocks: Serve to structure a schedule so appointment types occur at specific times during the session.
  • Visit Types: Basic visit types are created and leveraged for each department.
  • Visit Type Modifiers: Used to restrict slots based on duration, age, gender and special instructions.
  • Partner with the Center for Ambulatory Services (CAS) for help with ongoing template management or designate a minimum number of staff in your practice/department with responsibility to create and manage templates; this creates a richer set of expertise and minimizes cases of templates with extreme variation from practice norms.

  • Train your end users to use the correct visit types, schedule using auto schedule, and follow the guidelines and template build put in place.

  • Minimize and standardize visit types across your department. Are there visit types you can merge or remove?
  • Standardize visit lengths across department to 20/40/60 minutes or 15/30/45 minutes.
    • What is the shortest visit length? This should be your default. All other visit lengths should be multiples of the default. For example:
      • Office visit: 15 minutes (default)
      • Physical: 30 minutes
      • New patient: 30 minutes
      • Procedure: 45 minutes
  • Avoid regular use of the following scheduling tactics:
    • Double booking
    • Overbooking
    • Booking outside the template
    • Use of held time
  • Regularly check the clinicians listed in your department and remove any who no longer work there.
  • Report on outcomes. Plan a long-term maintenance and reporting strategy to monitor changes in clinician utilization and demand.
  • Set goals for utilization or no-shows.
  • Implement 4-hour standard sessions with consistent start and end times.
    • Recommendation:
      • Morning session: 8 am–12 pm
      • Afternoon session: 1 pm–5 pm
    • Goal: >80% of sessions meet session standards
  • Use blocks or leverage session limits/minimums to build in slots for:
    • New patients (must reflect budgeted new-patient volume)
    • Urgent appointments (to accommodate clinically urgent needs)
  • If blocks are used, the Block Release function must be used. Departments should identify the appropriate predetermined interval based on block type and practice needs.
  • Unblocked time in Epic means that any visit type can go into those slots.
  • A block should always be linked to a visit type – determine which visit types should be linked.
  • Blocks tell a visit type where it belongs.
  • Determine whether the visit type can go into both blocked and unblocked time.
  • Determine what happens if no appointments are scheduled into the blocked time within a given time.
  • Use unblocked to allow the visit type to go into blocked time as well as unblocked time.
  • Ensure that scheduling your visit type is flexible, when appropriate.
  • Time release blocks so that unused slots become unblocked.
  • Make sure unutilized blocks are removed from the schedule.
  • Use start and continue blocks to ensure ranges of blocks are utilized.
  • Start 30-minute visits in the first and third 15-minute slots of an hour of blocked time.
  • Block scheduling restrictions
  • Can only be scheduled into the block on the day of the appointment
  • Overview of blocks
  • Use visit type limits to determine how many visits can be scheduled in a period.
  • Prevent scheduling too many of a particular visit type.

Check for:

  • Release date (no release date or a release date in the past)
  • Mismatching slot and visit type lengths
  • Multiple slot lengths
  • Missing blocks

There are many barriers and obstacles to increasing schedules and/or utilization. Here are some tips on what you can do to address these issues.

Barrier Suggestions to Address It
Too many blocks in a clinician’s schedule Talk to the clinician about opening some restrictive blocks to allow for other visit types.
Late patients

Think about adding guidelines for patients and clinicians.
No-show patients

Strategically add openings.
Last-minute schedule requests by clinicians Develop a process.
Resistance to change Talk to your practice leadership about setting expectations for time off requests and schedule changes. Encourage clinicians to make up time if a session gets cancelled.
Clinicians are picky with their schedules Talk to your practice leadership about working through this issue and steps that might work for your practice. Show the clinicians the data on utilization. Talk through some of the benefits of changing the schedule; it could be a win/win.
Users have too much security to bypass scheduling restrictions Think about removing security from schedulers if it is not needed. You can also put stricter guidelines in place for schedulers. Run the reports on a regular basis to ensure compliance.
Gaps in the schedule can’t be filled because none of your visits match the unused length Ensure that at least one of your visit types is the same length as your template slots.

If you would like more information or are unfamiliar with these functions or concepts, team members from the Practice Improvement Division can help.

Remember:

  1. Templates alone will not solve your scheduling problems; optimized templates organize your clinical resources, but optimized scheduling workflows are also important to ensure efficient, patient-centered access and scheduling activities.
  2. Cadence has a large menu of solutions with advanced functionality to support your practice needs; the Practice Improvement Division can help you assess which tools are right for you and design a workplan for implementation.
  3. The Practice Improvement Division works closely with the Epic Cadence team and will help connect you with the most appropriate Cadence resources, including training.

Tips

  • Determine how long appointments in your departments take.
  • Use standardized slots and appointment lengths.
  • Adjust your visit type lengths.
  • Review your blocks and the current demand for those slots.
  • Remove unnecessary blocks.
  • Use time release for blocks.
  • Allow visit types to be scheduled into unblocked time.
  • Set up session limits.
  • If you use questionnaires, update them accordingly.
  • Set general scheduling philosophies.
  • Consider building schedules with one consistent slot length.

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