Why it’s such a headache to schedule a doctor’s appointment


The Waiting Room at Highland Hospital in Oakland, Calif. in the film "The Waiting Room." Image courtesy of International Film Circuit

In an age where you can book a flight, hotel room or change your airplane seat reservation on a moment's notice, how is it that finding a time to see your doctor is still such a chore?

The answer is actually pretty simple, says Oliver Kharraz, founder and chief operating officer of ZocDoc, a service for scheduling doctor's appointments online. It's  because technology hasn't made the physician's appointment book more efficient; it's actually tied the system into knots.

By his count, there are more than 1,400 different scheduling management systems for doctors' offices in the U.S., very few of which spoke to each other.

"There's no single one that has a double-digit market share overall," he said. "It's as fragmented as you can imagine. My belief is that health-care IT is the most fragmented overall."

Some doctor's offices use up to 12 systems just for their own basic scheduling needs, he said. The ecosystem is so fragmented that despite clear enthusiasm for the company--Fortune reports  it is now worth $1.6 billion after its latest round of funding-- it's taken ZocDoc several years to roll out what seems like it should have been a very simple thing to fix.

There are lots of reasons for this, he said. Hospital groups merge, for example, and may find it easier to run parallel scheduling systems than to try and unify them. A doctor may have a particular preference for one system over another. Or administrative assistants may have preferences, based on how they've been trained.

All of that, Kharraz said, means that appointment changes, cancellations and notes about doctor vacations end up on sticky notes, or scribbled into margins, exacerbating the time crunches that physicians already face.

"We call this the hidden supply of health care," Kharraz said. "Those appointments that change at the last minute, that get canceled, the no-shows...are about 25 percent of appointments."

The national average to get in to see a doctor is three weeks, Kharraz said. ZocDoc customers, on average, are able to slip into the holes in scheduling systems to see someone in 24 hours, he said.

Kharraz argued that many of the backlog problems that hospitals--veterans hospitals, for example--have to deal with on a daily basis could be alleviated by just getting all of their appointment books on the same page. A June report from Politico noted that the VA has long been looking for a way to update its scheduling system, and has issued a request for proposal to find a system that will do just that.

If Kharraz had to give advice to hospital systems such as the VA, his first recommendation would be to start small and think about unifying the scheduling systems -- even before launching into big plans to add hospitals, doctors and offices. That way, they could quickly get an idea of physician supply and patient demand, before larger reorganization efforts.

" The number one point is that they should pick a solution that can be implemented quickly and incrementally," he said. "Large programs...not only take a long time and cost a lot of money, they also have a high rate of failure."

Hayley Tsukayama covers consumer technology for The Washington Post.
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