Date: 03/01/2015

The Access Initiative seeks to open up access while making it easier to get patients to the best doctor for their condition. When patients call Johns Hopkins to schedule an appointment, they should expect to get one within a reasonable amount of time with an appropriate provider. However, delivering on those expectations has been difficult at times.

But now that is changing. The Access Initiative, which relies on the advanced use of Epic, aims to make it much easier for patient access coordinators to schedule patients with the right provider at the location and time that work best for patients. And it implements best practices for providers’ management of their clinic schedules, opening up availability and increasing patient volume.

The divisions of Cardiology and of Gastroenterology and Hepatology, and the departments of Otolaryngology–Head and Neck Surgery, Plastic and Reconstructive Surgery, and Orthopaedic Surgery took part in the initiative, whose first phase ran from January through December 2014. Improvements led to a 21 percent increase in the proportion of calls handled within 30 seconds, a 17 percent increase in providers’ schedule utilization—the number of booked hours divided by the number of available hours—and a 26 percent decrease in provider-initiated cancellation rates.

Building on previous efforts to increase access, the initiative is sponsored by William Baumgartner, president of the Office of Johns Hopkins Physicians; John Flynn, executive director of the Clinical Practice Association; and Ron Werthman, chief financial officer for the Johns Hopkins Health System.

Says Baumgartner: “The Access Initiative is all about becoming more patient focused. We are creating an environment in which patients can easily make appointments and referring doctors can easily obtain consultations with our physicians.”

Epic Helps Schedulers Handle Calls Efficiently and Accurately

In the recent past, scheduling required opening multiple screens to compare what conditions doctors treated, when they were available and where they practiced.

“Scheduling patients has been laborious and inexact, and has relied in great part on each scheduler’s memory,” says Epic consultant Agnieszka Twarowska.

“The list of symptoms and diagnoses was mindboggling,” says Elizabeth Davis, a patient access coordinator. “Now the system asks questions and, based on the answers, comes up with list of doctors compatible for the patient, along with their locations and schedules. We don’t waste patients’ time, and we can assure them we’re getting them to the right provider.”

Not only are patients better served, but improvements also make it easier for new patient access coordinators to learn the job.

Better Management of Provider Schedules

Steve Sisson, an internist who is co-chair of the Access Initiative, says that national best practices are helping guide the project. “Physicians have tended to build their schedules in a way that became counterproductive over the long term—for instance, building customized slots for specific types of patients but not filling them, or blocking slots intended for clinic and using them for meetings instead. So we have gotten down to the very basics: What is a clinic session? What is an office visit? What is a return visit? When you start to follow best practices, you tend to open up access.”

He points to Ophthalmology and Dermatology as two departments that implemented much of this standardization on their own. “Years ago, in my internal medicine practice, patients would come see me with an unusual rash, and I used to cringe because it was so hard to get someone in to see a dermatologist. Now those patients usually have same-day access.” 

Sisson says the initiative is also reminding physicians to avoid canceling patient visits within 30 days prior to the appointment. If a physician has a foreseeable event, such as a conference to attend, that physician should block out the time on the scheduling template well in advance rather than letting it fill up and then canceling the appointments, says Sisson. 

The Project Puts the Patient First 

The project’s aim is to implement a truly patient- and family-centered access model, says Vivian Zhao, director of access process improvement, and its success rests on collaboration. 

“The critical success driver of this initiative is the partnership among physicians, administrators and patient access. This truly has been a collaborative process.”