In the military medical system there are currently two methods for making appointments; through the central appointment desk or by calling the clinic directly. At the 18th Aerospace Medicine Squadron, the optometry clinic is tasked with making all patient appointments. The optometry clinic is staffed with three optometrists and three optometric technicians. On average, the technicians schedule 20 appointments via the telephone per day and answer another 10 questions regarding appointment availability. Depending on the number of appointments needed by the caller, the length of the call may be up to five minutes. With the telephone ringing throughout the day one technician is literally "tied to the telephone" while the other two technicians screen, perform auxiliary tests, and order spectacles for the 45 patients seen each day.
In August 2000 one of our optometry technicians, Sgt Frank Miller, asked an intriguing question, "Why can't we book all our appointments on the Web?" After some investigating, we found that some clinics (civilian and military) are using an e-mail appointment request system. However, we concluded that this system could actually add to our workload by requiring the clinic to e-mail the patient back with the date and time, hope the patient receives the message, and that the date and time of the appointment are acceptable. We decided to go one step further and display all our appointments on the Web in real-time. The same interface the technicians use to schedule patients would be available to our patients.
The next six months were spent learning "the language of the Web", in our case ASP or Active Server Pages. Our goal, by using this technology, was to load all of our appointments into a database on a Web server that could be accessed via the Web by both our patients and staff. With this type of system, a daily report could be printed that listed all appointments made during the preceding day. The appointment information could be entered into the Composite Health Care System (CHCS) by the technicians between patients or during other slow periods throughout the day. Entering the data takes approximately 20 seconds per patient. CHCS is used throughout the Department of Defense (DoD) medical system for scheduling appointments, prescription drug management, radiology test ordering, etc. CHCS would mirror the online database. Updating the system would be as simple as importing an ad-hoc CHCS report into the online database whenever new appointments are opened, usually every week or two. Generating and importing the report takes approximately three minutes.
On March 1, 2001, we opened our schedules for active duty patients to book via the Web. The response was so overwhelmingly positive from patients and staff that we opened it for dependents 15 days later. We have seen an 80 percent reduction in telephone calls to the clinic thus freeing the technicians from the telephone. Over 96 percent of our patients prefer the online appointment system to the traditional telephone-based system. The same percentage would like to see other clinics adopt this same system.
The advantages of this system compared to traditional telephone-based scheduling are numerous. Patients are able see the entire list of available appointments in real-time. As soon as a patient cancels their appointment, it is immediately available for scheduling by other personnel. Patients can schedule and cancel appointments 24x7. Dependent appointments can be scheduled from home or a government computer while active duty appointments can be scheduled from a government computer. Patients receive e-mail appointment reminders automatically sent by the online application at scheduled intervals. Patient feedback can be obtained anonymously via an e-mail form - our response rate has been greater than 55 percent. The majority of feedback messages are received within a few minutes of being sent. This allows rapid response to possible problems.
Another significant and unique benefit, especially for busy practices like ours, is the Cancellation Notification System. Patients who have broken their spectacles, lost their contact lenses, are going TDY (temporary duty) or just need an appointment as quickly as possible can sign up to receive an immediate e-mail notification in case of a cancellation. Patients enter a date and time range for when they would like an appointment. As soon as a cancellation comes in, an e-mail is sent to patients who registered for those dates and times. The Cancellation Notification System has eliminated a significant number of calls and "yellow sticky notes" on our technicians' monitors.
SAIC, the company that is contracted to run CHCS, offers an online appointing system as part of an upgrade package called "Virtual Office" for $200,000. This system interfaces directly with CHCS but our online system does not. CHCS II, is scheduled to include an online appointment system similar to the current offering by SAIC. Even though the system we developed does not interface directly with CHCS, the savings in time both for our staff and our patients and most importantly the increase in quality of patient care have made it a worthy endeavor.
Captain Bockhorst, USAF, BSC is a member of the Biomedical Service Corps. The BSC includes pharmacists, optometrists, public health officers, physician assistants, bioenvironmental officers, and physical therapists. Captain Bockhorst is the Chief, Optometric Services Kadena AB, Okinawa.