Opportunity  

Clinical practices need a reliable way to reach patients regarding appointment logistics, review and respond to important patient experience feedback, and manage inpatient visitation. This communication is important for operations, as it permits clinics to fill open spots, improve patient experience, help facilitate safe visitation, and more. Manual aspects of this work can be time-consuming for staff and inconvenient for patients.

Intervention  

Switchboard is an appointment-based communication platform that leverages automation to reduce staff burden and increase operational efficiency.

Initially built for conducting virtual care visits during the COVID-19 pandemic, Switchboard now encompasses three solutions. First, Switchboard is used to develop and deliver appointment reminders to patients through automated text messaging. Second, Switchboard continues to function as a telemedicine platform for special cases. Third, it powers feedback collection for the health system (please visit the Penn Medicine Experience page for more information).

Switchboard Appointment Reminders allows clinical and administrative staff to easily craft templates and automate message delivery according to customizable criteria. 

The system is integrated with the electronic health record (EHR), enabling real-time syncing when a patient confirms or cancels an appointment. Outcomes are collated and shared with clinical and operations staff via a user-friendly dashboard. Switchboard’s configuration flexibility has also allowed us to experiment with message wording and delivery so we can learn which are most effective for reaching patients and reducing no-shows.

The Switchboard team continues to enhance the platform. For example, we expanded language capabilities – messaging can be delivered in English or Spanish – to better communicate with different populations. Switchboard’s messaging applications have also extended to other uses such as security screening.   

Impact  

Switchboard Appointment Reminders are used for nearly all Penn Medicine outpatient visits – about 15,000 appointments per day. This in-house solution has reduced costs on messaging compared to the SMS solution previously used while providing benefits like customizability and better EHR integration.

In a pilot run with the Department of Dermatology, sending reminders three weeks before, three days before, and the day of an appointment reduced the no-show rate by nearly 2 percentage points compared to single messages. More recently, in partnership with the Patient Access team and Division of Infectious Diseases, we learned that setting up automated calls to patients deemed at high risk for missing an appointment led to fewer no-shows – another drop of almost 2 percentage points.

Both interventions – the “3-3-3” messaging scheme and automated calls for patients predicted to no-show – are now used across most Penn Medicine departments and sites. The improvement in the no-show rate is worth an estimated $7 million per year in additional revenue as practices are able to fill slots that would have been wasted.

Switchboard’s telemedicine application enables patients to receive high-value virtual care from the comfort and safety of their homes. The platform supported approximately 30,000 virtual appointments a week at its peak. Today it fills in the gaps when Epic’s platform cannot be used.