NYC Health + Hospitals is the public healthcare delivery system serving New Yorkers, regardless of national origin or ability to pay. Its primary care footprint encompasses 11 essential hospitals and more than 50 community health clinics throughout the five boroughs.

THE PROBLEM

The public health system has 5 million annual scheduled visits, and a historic missed appointment rate (no-show rate) of roughly 20% to 40%. Previous appointment reminder systems were either limited, costly, inconsistent, fragmented, not integrated with other systems or not patient-friendly.

For a health system so massive and diverse, missed appointments lead to gaps in care for patients, lost revenue and resource underutilization, decreased access for other patients, and disruption in the clinic.

“Our health system treats some of the most vulnerable patients in New York City, many of whom are unengaged or even afraid to seek healthcare due to immigration status,” said Kaushal Challa, senior assistant vice president of ambulatory care coordination at NYC Health + Hospitals.

"Providing language-concordant reminders is essential to serving a diverse patient population, even if the cost of managing multiple languages is not compensated in our current healthcare system or in the telecommunications industry at large."

Kaushal Challa, NYC Health + Hospitals

“They might work multiple jobs, or serve as caregivers for their children or aging family members,” he said. “They could face unreliable commutes to clinics or simply have to make the difficult decision to prioritize other responsibilities ahead of going in for a doctor’s appointment.”

A missed appointment is a missed opportunity to engage the patient on their healthcare and may be a patient lost forever, he added.

“Furthermore, as a public safety net health system, we treat patients regardless of their insurance status or ability to pay,” he noted.

“So doing as much with our capacity is important. Missed appointments also impact the access to other patients, as well. Another patient could have used that appointment slot, and having convenient access for patients is a system goal. Our clinics need to make real-time decisions, including squeezing in sick walk-in patients, and knowing ahead of time what availabilities the clinic has is crucial.”

PROPOSAL

The provider organization turned to health IT vendor Lumeon’s Care Pathway Management platform to automate and improve communication for patient appointments.

The goal for NYC Health + Hospitals was to empower patients to cancel and reschedule appointments they can no longer attend, empower practices to make informed decisions regarding same-day accommodations, and expand language access to reflect the population served – all while integrating the process seamlessly with the electronic health record and scheduling system, so allowing the city’s public health system to sunset old, antiquated or fragmented systems.

NYC Health + Hospitals has deployed across five of its facilities. The health system plans to expand rollout across all of its 21 sites by the end of 2020, integrating the system with its Epic EHR system.

“Before the implementation, the technology was intended to notify patients of appointments through text, e-mail or automated calls, based on a patient’s preference,” Challa explained. “It was critical that the solution was available in a number of languages to accommodate the needs of our diverse patient population.

“The platform needed to integrate with NYC Health + Hospitals’ existing scheduling system, collect patient responses to confirm, cancel or request to reschedule through multiple modalities, and provide the ability for proactive communications with patients, such as emergency clinic closures and flu shot campaigns.”

Logistically, the platform also was expected to report actionable data on visit confirmations and cancellations to sites, and replace all various legacy reminder systems previously employed by the system.

MARKETPLACE

There is a variety of patient engagement and communication systems on the health IT market today. Some of the vendors of these technologies include Casetabs, Demandforce, Lumeon, Medici, OhMD, Patient Trak, PerfectServe, Revenue Well Systems and Solutionreach.

MEETING THE CHALLENGE

In July 2019, NYC Health + Hospitals deployed the Lumeon automated appointment-reminders system to deliver SMS reminders to adult patients at NYC Health + Hospitals/Coney Island three days and one day before primary care appointments. For reference, primary care is broadly defined, including visits with providers, nurses, financial counselors and other team members.

Patients without mobile numbers or who opt-out of SMS reminders receive reminders through interactive voice response or e-mail if such details are available. The reminders prompt the recipient to confirm, cancel or reschedule the appointment.

Language access was critical for the city’s public health system. The platform allowed communication to be deployed in 14 languages for SMS reminders, with eight languages for voice response. Responses by patients were integrated into the medical records and accessible to frontline staff to assist in accommodating other patients.

In December 2019, the platform was expanded to include adult, adolescent and pediatric primary care in three additional hospitals and one community health center. In 2020, NYC Health + Hospitals will expand the text-message appointment reminders to all patient sites, and will expand to other specialty areas. The organization also will begin to explore other patient use cases, including public health campaigns and mobile insulin titration.

RESULTS

Since its implementation at NYC Health + Hospitals/Coney Island in July 2019, Lumeon-powered patient communication reduced missed appointments by 6.1%, helping to make appointment scheduling more efficient.

To date, NYC Health + Hospitals has sent approximately 95,500 automated reminders, with 96.4% of these reminders delivered in the patient’s preferred language. Additionally, 53.1% of messages were sent in a language other than English.

At NYC Health + Hospitals/Coney Island, the broken appointment rate for adult primary care has decreased from 26.9% to 20.8% between comparable 21-week time periods in 2018 and 2019.

ADVICE FOR OTHERS

Challa said the organization has learned a number of lessons along the way.

“Providing language-concordant reminders is essential to serving a diverse patient population, even if the cost of managing multiple languages is not compensated in our current healthcare system or in the telecommunications industry at large,” he advised.

“Also, think carefully about the frontline user’s experience. What are you expecting them to do? Does the solution make their life easier, or does it make it more burdensome?”

Simpler solutions that integrate well with existing systems may work better than more sophisticated but complex ones, he added.

“And don’t think of no-show rates as the patient’s fault,” he concluded. “It may be a reflection of the way you engaged them, or the quality of the appointment you gave them in the first place.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com
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