As radiology departments continue working through their backlog of delayed exams, one West Coast provider is finding tremendous success letting patients steer the process.
After canceling all nonurgent appointments in March 2020, the University of California, San Francisco, was grappling with long call center wait times and a decrease in scheduled exams. So, the institution decided to skip traditional outreach and redeployed some schedulers to screen patients for COVID ahead of exams.
UCSF kicked off the effort in May 2020 starting with screening mammography. But the initiative spread like wildfire, now encompassing CT, dual-energy x-ray absorptiometry and some MR areas.
As of late February, San Francisco patients had arranged almost 5,000 exams on their own across six imaging centers, saving more than 400 hours of scheduler time. Call center wait times have also plummeted, as have no-shows, reschedules and same-day cancellations, noted Christina Bronsky, manager of clinical systems at UCSF Health.
“It’s been on a radar for a long, long time,” she told Radiology Business. “Our original scope for the project was tiny; it was start with screening mammography and then move on to something else, potentially CT. With COVID, we just decided to go full-steam ahead and implement everything that we possibly could as fast as we possibly could,” she added later.
UCSF had already been piloting such self-scheduling in ambulatory care, prior to the pandemic. The technology functions through the hospital system’s patient portal, triggered when a physician places an order for imaging in the electronic health record. Afterward, it evaluates some rules behind the scenes to decide whether the individual is eligible for online scheduling. Certain factors, such as whether the exam requires anesthesia, necessitate an additional phone conversation.
If the answer is yes, it sends the patient a notification in the portal and a text message or email prompting them to sign in and schedule the scan. They also fill out a pre-exam questionnaire with details such as whether their last mammogram occurred outside of UCSF, requiring the system to seek out those films beforehand, pushing the appointment date back.
Since May, patients have now schedule roughly 33% of mammo exams, 31% of DEXA, 12% of CT and 4% of MR. They’re now continuing to work through MR and x-ray, with plans for ultrasound and diagnostic mammography slated in the coming months, as they seek to spread this throughout the outpatient imaging enterprise.
Bronsky said there have been a few challenges, including technology limitations when scheduling combo exams, some duplicate orders, a few patients trying to “game” the system, and language barriers with patients who don’t speak English. But she urges peers to dive in and give patient-steered scheduling a try, too. She believes this was relatively rare in radiology prior to COVID but starting to spread as others grapple with the same challenges.
“Pick an area and just go for it,” she said.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.