An Interactive Outpatient Reminder System

摘要

There is a distinct value add in terms of lost revenue for patients that do not attend clinic appointments. The cost of patients not attending clients is now directly contributing to the inefficient control of the health services with the associate cost per patient now estimated at 100 euro on average with an average yearly lost of 400 million estimated. The ability to improve and reduce the number of patients that attend outpatient appointments is seen as a vital component in the continuing efforts to introduce efficiencies in this sector of healthcare. The system proposed here is an interactive, two-way messaging system that not only alerts patients to upcoming outpatient appointments, but also facilitates a quick and seamless reply path as to whether they will attend or not the clinic. This communications pathway is allows for effective patient management and control. Background There is now a recognised paradigm shift in the delivery requirements of healthcare at both a national and international level. Due to the changing shape of world populations, long term and chronic care patients will dominate the healthcare sector in the near future [1, 2]. This is based on increasing life expectancies and reduced birth rates. Traditional health services are experiencing an increased burden as they try to adjust to this dynamic change, with 80% of GP consultations, 60% of hospital bed days and two-thirds of emergency admissions related to patients with chronic and long term conditions [3]. Clinical and out-patient appointment numbers are set to increase in line with this shift in healthcare requirements. Missed appointments or “Did Not Attends” (DNAs) represent a substantial cost for both public and private healthcare service providers [4]. It has been shown that the average cost per patient not attending clinics is 100 euro[5]. Figures released in 2004 outline that almost 9 million appointments are missed each year, with these numbers set to increase in line with increased numbers of long-term care sufferers [6]. Patients who do not attend for their hospital appointments prevent other patients on the waiting list for receiving prompt treatment. This poor control of patient flow in turn contributes to increased waiting times, now estimated at being over 13 weeks [7, 8]. In response to these problems, healthcare providers have looked at introducing new outpatient booking systems as well as targeting repeat offenders with letters via post [9]. The problem of DNAs reflects the fact that patients have a key part to play in primary care [10]. However, the majority of solutions in existence depend on a ‘partial booking' system whereby patients receive a letter asking them to ring in a date that best suits them. Such systems have a short term benefit with a 12% decrease in DNA numbers being reported [11 web-medical news]. However, there are inherent problems with such a solution, the most obvious being the delay in making and attending an appointment. This delay, sometimes upto 6 months, can cause patients to miss their appointment date as well as allowing them no flexibility in re-scheduling. Methods This paper focuses on the use of Valentia's Outpatients Reminder and Paging System (ORPS). This two-way messaging system enables Outpatients Departments in hospitals and clinics to tackle the problem of DNAs. Using ORPS, outpatient departments can send SMS appointments reminders to patients at predefined intervals and times prior to their scheduled appointment dates. ORPS also gives patients an ability to cancel or reschedule their appointment if they are unable to attend, thereby allowing managers to notify alternative patients of available freed-up appointment times. ORPS can play a similar role in GP practices, chronic disease management clinics and day cases. ORPS is driven by an enterprise level gateway service that allows for two-way communications behind patient and hospital server. Patient record files existing on Patient Administrati