I recently met with directors of the Camden Coalition, which is seeking to radically change the way residents of Camden, New Jersey seek and receive care.  To provide context, Camden, New Jersey was America’s poorest city as of 2006 (pdf article) and one of its most violent.  Furthermore, over 50% of Camden residents visit the ER room in a year, which is over double the national average in the U.S.

This over-usage of ER rooms led a group of New Jersey physicians and public health officials to undertake the ambitious effort of tracking ER “super user” characteristics over time in order to make Camden residents healthier while lowering overall medical costs.  According to Dr. Anthony Mazzarelli of Cooper Health, who directs Cooper’s ER room and has been named one of ten Outstanding Young Americans and hosts a radio show, the ER over-usage results not only from many Camden residents lacking insurance, but also many insured residents lacking physician relationships.

In a program led by Dr. Jeffrey Brenner, the Camden Coalition is now hyper-targeting those ER super-users with an all-encompassing care management program by having physicians and public health workers promote preventative care and healthier lifestyles among these patients.  Furthermore, the Coalition has a broader goal to reach out to all Camden residents to increase access to preventative care through open access scheduling (see our previous post about open access scheduling).

A key lynchpin of their effort is effectively utilizing electronic medical record information, as a patient health record helps physicians better track and serve patients.  DocAsap also believes that online technology can help patients find appointments or interact with doctors remotely.  While internet usage in poorer areas typically trails that of wealthier communities, Camden’s young population, many of whom have cell phones and use the internet regularly, could benefit from having online tools such as DocAsap to more easily get doctor appointments.  DocAsap believes that providing intuitive doctor appointment search tools to all Americans that it can decrease over-usage of ER rooms, reduce overall healthcare cost, and create a healthier U.S. population.

This sure is an extreme statement. However, I firmly believe that open access to doctor booking systems would provide significant value for both doctors and patients.

Years ago, people who needed to see a doctor simply walked in, “took a number” and waited for their turn. At that time appointment scheduling was a welcome change as it brought order to the chaos. However, the results did not meet expectations. Appointment systems became complex and frustrating. Despite proper scheduling, the appointments were rarely honored. Double and triple booking by doctors to mitigate no-shows resulted in the same old wait-your-turn system.

Not just this, the need for timely access pushed more and more patients to emergency room care. Studies show that more that 50% of HMO patients would have preferred a day or two wait for their primary care instead of going to an ER. It’s just that the receptionist telling them “come next week” led them to an ER.

Open access eliminates most of these issues.

Wouldn’t it be great if you could be sure that when you call your doctor, he/she would see you either today or tomorrow instead of making you wait for weeks?

In the book, Strategic Management of Health Care Organizations, the authors talk about one such open access scheduling system – developed as part of idealized design of clinical office practice IDCOP – in Jefferson County, Alabama. The system required the doctors to provide for same day appointments. When implemented the results were startling:

• Contrary to popular belief, physicians were fine with the guarantee of same day appointments
• Revenue increased by almost 10%
• After 6 months average appointment wait time was reduced from average 46 days to 5 days
• No show rates reduced from 56% to 19%
• New patients per month increased from 78 to 95

Needless to say, the results were so amazing that Jefferson County adopted the same-day scheduling system.

Clearly, medical practices can create considerable value by enabling patients to see the doctor promptly by improving existing appointment scheduling systems. I believe DocAsap would prove to be a prominent open access mechanism that would create value for both doctors and patients.