Reducing no show rates through the use of eReferral

Missed appointments (no-shows) are a significant issue in primary care settings,^1,2 with many medical care clinics reporting no-show rates as high as 23-34%.² Failure of patients to show up for their scheduled appointments is a misuse of providers’ time, and inadequate utilization of clinic resources.^1,2,3,4 Young age, type of visit, long wait time to access care, forgetting the appointment time and miscommunication of information are among the reported causes of no-shows.^1,3

Digital health tools are valuable resources that can support a streamlined workflow within clinics. The Ocean eReferral network (eReferral) is an electronic solution that has been deployed across seven subregions in Ontario to support patient care. To date, over 100,000 referrals have been processed by over 1000 clinicians using the eReferral solution. Ocean eReferral generates automated email notifications throughout the referral process for patients to track their referrals and support administrative staff on notifying patients of their appointments.

Patients who receive email notifications regarding their referral are able to confirm their appointment online and have an email record of their referral and appointment instructions. A reduction in miscommunications and appointment no-shows is anticipated.

MyHealth Centre, an independent diagnostic health facility in Ontario, went live with eReferral at their four South Western (SW) clinics in November 2019. A Physician Relations Representative (PRR), at one of the clinics, manually tracked appointment no-show rates among patients who were referred through Ocean eReferral and received an email notification, as well as those referred by the traditional method with no automated email notification. The PRR also recorded the amount of time spent by staff notifying patients who did not receive automated email notifications regarding their scheduled appointments. Data was tracked from December 1, 2019 to February 29, 2020.

Benefits​

eReferrals from MyHealth, South Western Ontario, since Ocean eReferral Go-Live:​

• 71% of the patients have a booked appointment​
• 14 clinicians have adopted and sent referrals electronically to MyHealth​
• Average wait time to access care is 19 days​
• 72% of patients consented to and received email notification of their referral​

The following observations were recorded at ​MyHealth in South Western Ontario based on ​315 eReferrals to MyHealth:​

• Less Time Spent Notifying Patients of their Appointments – In February, MyHealth tracked a time savings of 70 minutes as most patients referred electronically received automated email notifications and therefore did not require calls. If all patients received emails through the eReferral solution, there is a potential time savings of more than 3.5 hours per month​
• Fewer No Shows – Tracked no shows from December 2019 to February 2020 illustrate that those referred through eReferral were 0.9% less likely to miss their appointment​

Acknowledgements

The Ontario eServices Program delivers digital services (eConsult and eReferral are the first initiatives in the scope of the program) that support clinical workflows and facilitate smoother transitions in care and an improved patient experience. The Ontario eServices Program is co-led by the Ontario eConsult Centre of Excellence (eConsult COE) and the eHealth Centre of Excellence (eCE) and is funded by the Ontario Ministry of Health (MOH).

1. Parikh A, Gupta K, Wilson A, et al. The Effectiveness of Outpatient Appointment Reminder System in Reducing No-Show Rates. The American Journal of Medicine. 2010;123(6): 543-548
2. Liu A. Optimal Choice for Appointment Scheduling Window Under Patient No-Show Behaviour. Production and Operation Management. 2015; 25 (1):128-142
3. Kaplan-Lewis E, Percac-Lima S. No-Show to Primary Care Appointments: Why Patients Do Not Come. Journal of Primary Care and Community Health. 2013;4(4):251-255.
4. Bigby J, Pappius E, Goldman L. Appointment Reminders to Reduce No Show Rates. JAMA. 1993;250(13):1742:1745.
5. Pew Research Centre. 2020. Retrieved from :https://www.pewresearch.org/fact-tank/2019/09/09/us-generations-technology-use/