Follow this microjourney™ to explore extendable case types for creating, re-scheduling, or canceling medical appointments. These features enable healthcare organizations to increase the effectiveness of their patient services contact center with highly-satisfying workflows and a modern user experience that can be integrated with their scheduling systems.

• Business value
• Use cases
• Required applications
• Personas, channels, and usage
• Stages and steps
• Data model
• Enabling the microjourney
• FAQs

Business value

Intuitive and efficient appointment scheduling is a significant factor in patient satisfaction. This microjourney improves patient satisfaction by making appointments easier to schedule and update, making agents more efficient, and connecting the scheduling experience to customer relationship management (CRM) initiatives.

Use cases

Many large provider organizations, such as hospital systems, centralize scheduling into a one contact center and seek to standardize their scheduling processes. Integrated healthcare organizations, both in the US and elsewhere, might provide both plans and medical services. Both these organization types can follow this microjourney to achieve their goals by implementing the following functionality:

• Schedule new appointments for different medical services while interacting with the patients or with an authorized contact on the patient's behalf.
• Cancel appointments.
• Reschedule appointments.

This microjourney processes single-provider medical appointments. Complex appointments that require multiple providers and medical equipment, such as surgeries, are beyond the scope of this microjourney.

Required applications

• Pega Customer Service for Healthcare

Personas, channels, and usage

The following table shows the personas and channels for each use case in this microjourney. An assisted channel is where patients can speak or chat with agents, who can create or update medical appointments.

Patients seeking to update appointment times or dates want to do so quickly and easily. Healthcare organizations can empower patients to submit updates in their preferred channel. A chatbot to reschedule or cancel appointments has been included.

Stages and steps

This microjourney includes the following case types:

• Schedule medical appointment
• Manage medical appointment

Schedule medical appointment

This case type schedules new appointments.

Manage medical appointment

This case type reschedules and cancels existing appointments.

Data model

The following figures show the fields that are defined within the Schedule Medical Appointment and Manage Medical Appointment case types. All Pega case types can use fields defined within its inheritance path. Both cases also the Patient’s appointment information data type.

Enabling the microjourney

Use the Medical Appointment Scheduling, Manage Appointment, and Reminder Management case types in Pega Customer Service™ for Healthcare to update third-party systems and capture patient needs. With the Medical Appointment Scheduling case type, you can schedule new appointments for different medical services while interacting with the patients or with an authorized contact on the patient's behalf. With the Manage Appointment case type, you can cancel appointments or reschedule them for a different time or with a different provider. Reminder Management is a distinct case type that Schedule Appointment and Manage Appointment reference to create and update appointment reminders.

For example, you might add the names of family members who are associated with a patient or retrieve available appointment time slots for a provider. You can also extend the case to integrate with a variety of record systems such as Electronic Health Records (EHR) or Electronic Medical Records (EMR) systems.

Populating the list of patients that is associated with the caller

During a member interaction, you can retrieve a list of other family members when you extend the Medical Appointment Scheduling case. For example, you might want to schedule an appointment for another family member while you are in an interaction with a patient.

1. Open the D_GetAssociatedPatientsdata page.
2. On the Patient and subscriber associated details data page, save the rule to your ruleset by clicking Check out, and then clicking Saveas.
3. Click Create and open.
4. On the Definition tab, make your changes.
   For more information, see Data pages.
5. Click Save, and then check in your rule.
6. Close the record.

Retrieving the available appointment slots for one or more providers

You can retrieve the list of available appointment slots for providers in a third-party system when you extend the Medical Appointment Scheduling case.

1. Open the data page D_GetAvailabilityOfAProvider.
2. On the data page, click Check out and then click Save as to save the rule to your ruleset.
3. Click Create and open.
4. On the Definition tab, make your changes. For additional information, see Data pages.
5. Click Save and check in your rule.
6. Close the record.

Setting the duration for provider appointment slots

To set the duration for appointment slots for your providers, extend the Medical Appointment Scheduling case. For example, you can change the default setting of 15 minutes to 30 minutes.

1. Open the Patient's appointment information data type.
2. Open the Slot Duration dynamic system setting.
3. On the Edit Dynamic System Settings: Slot Duration page, on the Settingstab, enter a value that represents the duration of an appointment in minutes, and then click Save.
4. Close the record.

Setting the working hours for a provider

To set the start and end times of provider working hours, extend the Medical Appointment Scheduling case. For example, you can change the default start time for provider working hours from 0900 (9:00 AM) to 0830 (8:30 AM) and the default end time from 1600 (4:00 PM) to 1700 (5:00 PM).

1. Open the WorkingHoursStartTime dynamic system setting to set the start time or the WorkingHoursEndTime dynamic system setting to set the end time.
2. On the Edit Dynamic System Settings page, on the Settingstab, enter a value that represents the hours and minutes, and then click Save.
3. Close the record.

Determining when patients receive appointment reminders

To determine when appointment reminders are sent to patients, extend the Medical Appointment Scheduling case. For example, you can change the default setting of 3 days prior to the appointment for the first reminder to 5 days prior to the appointment. You might change the default setting of 1 day prior to the appointment for the second reminder to 3 days prior to the appointment.

1. Open the ReminderInformation map value.
2. On the Map Value: Reminder information page, click Check out and then click Save as to save the rule to your ruleset.
3. Click Create and open.
4. On the Matrix tab, make your changes. For additional information, see Completing the Matrix tab.
5. Click Saveand check in your rule.
6. Close the record.

Adding patient needs during appointment scheduling

To add a patient need during appointment scheduling, for example a provision for transportation to the appointment, extend the Medical Appointment Scheduling case. Based on that information, care team members can work with the patient to resolve the transportation issue.

1. Open the DoSpecialNeedsExist when rule.
2. On the When: Do special needs exist page, click Check out and then click Save as to save the rule to your ruleset.
3. Click Create and open.
4. On the Conditions tab, click the when rule and modify your values. For additional information, see Defining conditions for a when rule.
5. Click Save and check in your rule.
6. Close the record.

Capturing patient needs

To accommodate patient needs, for example, a transportation need or a nutritional need, extend the flow for the Medical Appointment Scheduling case.

1. In App Studio, open the Schedule Medical Appointment case type.
2. Go to the Capture Special Needs stage, and then select the Capture Special Needsprocess.
3. Save the CaptureSpecialNeeds_Extextension point into the implementation.
4. Modify the flow to meet your needs.
5. Click Save, and then check in your rule.
6. Close the record.

Retrieving provider availability slots in a third-party system

To retrieve the availability slots of providers who meet specific criteria in a third-party system, extend the Medical Appointment Scheduling case. For example, you might want a list of providers who speak Spanish, together with their working hours or availability, or a list of providers who are located in a certain area.

1. Open the PopulateProviderDetails_EXT data transform.
2. On the Data Transform: Populate provider details page, click Check out and then click Save as to save the rule to your ruleset.
3. Click Create and open.
4. On the Definition tab, modify the values for the data transform. For additional information, see Data Transform form – Completing the Definition tab.
5. Click Saveand check in your rule.
6. Close the record.

Creating, rescheduling, or canceling appointments in a third-party system

To manage appointments in a third-party system, extend the Medical Appointment Scheduling case. For example, you might want to create an appointment, reschedule an appointment, or cancel an appointment for your patient.

1. Open the PostDataToSchedulingSystems data transform.
2. On the Data Transform: Post data to scheduling systems page, click Check out and then click Save as to save the rule to your ruleset.
3. Click Create and open.
4. On the Definition tab, modify the values to meet your business needs.For additional information, see Data Transform form – Completing the Definition tab.
5. Click Save and check in your rule.
6. Close the record.

FAQs

1. What types of healthcare organizations need the Schedule Medical Appointment microjourney?
   Primarily provider organizations, such as hospital systems. Many institutions have contact centers for scheduling, and they seek to standardize scheduling and reminder processes.
2. Do these healthcare organizations already have scheduling applications?
   Yes. These capabilities interface with existing scheduling applications, instead of replacing them. The most common interfaces are Fast Healthcare Interoperability Resources (FHIR) APIs which belong to the HL7 standard). The new cases that are included in the Schedule Medical Appointment microjourney include extension points.