Scheduling in Digital Health

A Guide to Scheduling Vendor Selection

May 14, 2023

Hey there 👋

Welcome to another edition of TakeCare. We’re going deeper into digital health and getting nerdy about scheduling this time. I’ll go over some background on the space, break down the buy vs. build decision, and map out the different vendors in the space (note: this piece is written to the audience of a digital health provider, which I know many of you are not). For more guides like this one and to make better, faster decisions for your tech stack, check out Elion.

Scheduling is yet another inefficiency in the healthcare industry, but vendors are finding solutions. You can book a dinner table online with a click of a button. Why can’t you do the same for scheduling a doctor’s appointment? Healthcare is much more complex than other industries... nothing new here.

Huge thank you to Brendan Keeler at Zus Health, Colin Morelli, Cavan Klinsky at Healthie, Mark Olschesky from Butterfly Network, and Eric Guroff at Ratio for giving some incredible feedback on this piece.

Background

There are three parts of scheduling: validation, slotting, and booking.

For validation, providers need to make sure that they are seeing the right patients, which means confirming insurance coverage, prior authorization, and more.
Slotting refers to finding the appropriate time for a patient in a clinician’s schedule. The scheduler or scheduling system must have full information on a doctor’s scheduling preferences, the variability of certain appointment times, and other factors that affect availability. It is not easy to do slotting well and/or automatically because these factors are highly variable.
Lastly, there’s booking, which is the actual confirmation of an appointment in a particular time slot, while trying to avoid no-shows and double-bookings.

Due to the complexity of these parts of scheduling, we have been subject to indirect scheduling or having administrators coordinate visits between patients’ and clinicians’ schedules. In the ideal world of direct scheduling, where everyone can see a clinician's availability and book directly (like OpenTable), it seems like a win-win for everyone: doctors are able to see more patients, care navigation is more efficient, and administrators are working less.

However, it’s not a simple path there. Some doctors don’t want to see more patients and patients often cancel appointments. Additionally, appointments go longer than expected, and certain appointments take higher priority over others.

A perfect direct scheduling world is far away but there has been an influx of innovation recently. Health system platforms are starting to open up their APIs for other companies to use (ex. NexHealth) and ZocDoc is doing the same. Additionally, the CMS Prior Authorization API Rule and accompanying ONC regulation might be coming soon, which will allow for electronic prior authorizations. Let’s begin to dive into how these innovations can help your scheduling problems.

Build vs. Buy

Looking at this decision through the core competency framework, most of you are not trying to build your own scheduling platform in the long run. That being said, if you’re providing care in only a couple of states with a couple of clinicians, here is a scrappy way of making it happen (read more here from Mark Olschesky).

The scheduling manager manually updates the appointment time in the provider-facing application and the patient-facing application. This method doesn’t work at scale but is the easiest to stand up and works for both direct and indirect scheduling.

Additionally, if you are looking to build off of an existing technology, Shilling is another solution to mention. They are an early-stage vendor with both direct and indirect scheduling capabilities looking to license out their technology or sell their company (as of June 2022).

Companies

Healthcare scheduling tools have a long and storied history, generating dozens of companies. Given that all aim to solve the same underlying issue, it can be particularly tricky to decipher the small nuances that separate them. To simplify, the four biggest questions you need to ask yourself are:

Am I a big or small company? A smaller company usually has easier problems to solve.
Do I want direct scheduling? Direct scheduling will allow patients to see live doctors’ schedules.
Do I want my scheduling platform to come from my EMR vendor? An EMR add-on will reduce vendor bloat but lead to less flexibility.
Am I a care provider or selling to providers (aka am I working on one EMR or multiple)? Working with multiple EMRs reduces the efficiency of using EMR add-ons.

Check out this program to figure out which solution works best for you. The following terms will also help you distinguish between each solution. Most of these vendors if not all are platforms.

Managed services - the vendor outsources the service/technology end-to-end.
Solutions provider – a set of software and tools designed to tackle a single, specific problem.
Platform - platform solutions that offer a foundation that can address a number of use cases.
Develop toolkit - the vendor simply provides tools for the partner to create on their own.

When evaluating scheduling solutions, it’s important to consider them from an operational lens and a product lens. One question is how good is the vendor’s technology. But another question is how well does that technology improve your operations. In the words of Colin Morelli, “Better scheduling decisions can have a massive impact on utilization management. Better utilization maps directly to top-line revenue increase, and/or cost reduction.”

EMR-Based Solutions

You might be able to serve many of these needs out of your EHR. Some EHRs build out their scheduling platform internally while others use vendors, like Phreesia to satisfy their scheduling needs.

Pros: Using the scheduling inherent to your EHR reduces vendor bloat, which can simplify time spent on annual negotiations. Similarly, it's theoretically easier to stand up, as it’s built into your existing software.

Cons: However, scheduling is a drastically different job-to-be-done for different healthcare personas than EHR workflows like ordering or documentation. Additionally, these EMR add-ons are generally more rigid in terms of customizability and often have built-in assumptions that are not valid for newer virtual or value-based care models, such as multi-state scheduling or the assumption of fee-for-service charging.

Direct scheduling with Non-Healthcare-Specific Vendors

The easiest way to get started with direct scheduling other than the scrappy ways described in the build vs. buy section is to use a healthcare non-specific calendar app and manually insert appointment information into the EMR. This solution works for small companies with providers who are open to direct scheduling. The vendors that fit into this category are Calendly and Acuity.

Not being healthcare-specific comes with its downsides. The BD/Product people on their end won’t be speaking the same language as you. These companies also don’t have built- in workflows for insurance validation and should not be used for collecting Protected Health Information (PHI). If you plan on hosting any patient information on your scheduling system or integrating it into your EMR, these solutions don’t fit the bill. The use case here is for a small group of providers who need direct scheduling and aren’t willing to build something on their own.

(In)Direct scheduling with Healthcare-Specific Vendors

Next, there are healthcare-specific vendors that offer in-direct scheduling. Some of these are built for smaller companies and private practices, like Patientpop, while others are built to support larger volumes like BetterHealthcare.

As these companies don’t have the option for direct scheduling and have limited flexibility with company size, they’re less of a fit for the modern digital health startup with consumer-savvy tendencies. However, Mend offers a free version for smaller practices, with limited features (no direct scheduling). This option is fantastic for smaller organizations open to indirect scheduling.

Direct scheduling with Healthcare-Specific Vendors

On the direct scheduling side of things, there are a few healthcare-specific companies that offer both direct and indirect scheduling, making them a fit for a wide variety of cases. These companies include Source, Zocdoc, Healthie, Nexhealth, and Luma and usually offer other products in addition to scheduling. For a mid-size digital health company focusing on flexibility, these are your best bets. Below are a few of my favorite vendors and what makes them stand out.

ZocDoc integrates with 150+ EMRs. They have been around since 2007 and know the game.
Source’s bread and butter is scheduling which makes them stand out in the pack. In addition, they offer automatic task routing, drop-in messaging, and health data capture abilities.
Healthie has a number of other best-in-class products, such as patient-facing white labels. They could bit a fit if you are looking to reduce vendor bloat.
Nexhealth integrates with all major dental EMRs and a growing number on the medical side. Nex is a great fit if you are in the dental world.