Patient Opportunities to Self-Schedule in a Large Multisite, Multispecialty Medical Practice: Program Description and Uptake of 7 Unique Processes for Patients to Successfully Self-Schedule (and Reschedule) Their Medical Appointments.

Introduction: Patient self-scheduling of medical appointments is becoming more common in many medical institutions. However, the complexity of scheduling multiple specialties, following scheduling guidelines, and managing appointment access requires a variety of processes for a diverse inventory of self-schedulable appointment types.

Methods: From 7 unique patient self-scheduling methods, we captured counts of successfully self-scheduled and completed appointments.

Self-scheduling Medical Visits in a Multispecialty, Multisite Medical Practice: Complexity, Challenges, and Successes.

Background: Self-scheduling of medical visits is becoming more common but the complexity of applying multiple requirements for self-scheduling has hampered implementation. Mayo Clinic implemented self-scheduling in 2019 and has been increasing its portfolio of self-schedulable visits since then. Our aim was to show measures quantifying the complexity associated with medical visit scheduling and to describe how opportunities and challenges of scheduling complexity apply in self-scheduling.

Self-scheduling in a Large Multispecialty and Multisite Clinic: A Retrospective, Longitudinal Examination of Multiple Self-Scheduled Visit Types.

Background: Self-scheduling of medical visits is becoming available at many medical institutions. We aimed to examine the self-scheduled visit counts and rate of growth of self-scheduled visits in a multispecialty practice.

Methods: For 85 weeks extending from January 1, 2022 through August 24, 2023, we examined self-scheduled visit counts for over 1500 self-scheduled visit types.

Recommendation endpoints and safety of an online self-triage for depression symptoms.

Introduction: Online symptom checkers are a way to address patient concerns and potentially offload a burdened healthcare system. However, safety outcomes of self-triage are unknown, so we reviewed triage recommendations and outcomes of our institution's depression symptom checker.

Methods: We examined endpoint recommendations and follow-up encounters seven days afterward during 2 December 2021 to 13 December 2022.

Hospitalization Risk Associated With Emergency Department Reasons for Visit and Patient Age: A Retrospective Evaluation of National Emergency Department Survey Data to Help Identify Potentially Avoidable Emergency Department Visits.

Background: Patients often present to emergency departments (EDs) with concerns that do not require emergency care. Self-triage and other interventions may help some patients decide whether they should be seen in the ED. Symptoms associated with low risk of hospitalization can be identified in national ED data and can inform the design of interventions to reduce avoidable ED visits.

Online Self-Triage of Ear or Hearing Concerns in a Patient Portal: Comparison of Subsequent Diagnoses and Hospitalizations to National Emergency Department and National Ambulatory Ear or Hearing Visits.

Background: Although online self-triage is easily accessible, little is known about the patients who use self-triage or their subsequent diagnoses. We compared ear/hearing self-triage subsequent diagnoses to ear/hearing visit diagnoses in emergency departments (ED) and ambulatory clinics across the United States.

Methods: We compared International Classification of Diseases version 10 (ICD10) coded diagnoses following online self-triage for ear/hearing concerns with those from national ED and ambulatory clinic samples.

Self-Triage Use, Subsequent Healthcare Utilization, and Diagnoses: A Retrospective Study of Process and Clinical Outcomes Following Self-Triage and Self-Scheduling for Ear or Hearing Symptoms.

Background: Self-triage is becoming more widespread, but little is known about the people who are using online self-triage tools and their outcomes. For self-triage researchers, there are significant barriers to capturing subsequent healthcare outcomes. Our integrated healthcare system was able to capture subsequent healthcare utilization of individuals who used self-triage integrated with self-scheduling of provider visits.

Self-Scheduling Process Efficiency and Utilization of Online Self-Scheduling of Lab Tests: A Retrospective Analysis of Self-Scheduled Appointments for COVID Testing.

Introduction: The COVID 19 pandemic increased the need for rapid and accurate diagnostic testing for COVID. When testing became available, a systems response was needed to efficiently accommodate the high-volume flow of patients who needed testing. Self-scheduling of COVID testing was developed to help patients safely and efficiently schedule their COVID testing online or with a mobile app.

The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison.

Background: Screening mammography is recommended for the early detection of breast cancer. The processes for ordering screening mammography often rely on a health care provider order and a scheduler to arrange the time and location of breast imaging. Self-scheduling after automated ordering of screening mammograms may offer a more efficient and convenient way to schedule screening mammograms.

COVID-19 Care Clinic in a Medical Center: Lessons Learned.

Objective: The purpose of this report is to describe the elements of a Covid-19 Care Clinic (CCC), patient demographics, and outcomes.

Methods: Descriptive statistics were used to describe demographics, clinical characteristics, and outcomes. This report is based on 4934 unique patients seen in the CCC who provided research authorization within a 10-month period of time (April 1, 2020-January 31, 2021).

Impact of Web-Based Self-Scheduling on Finalization of Well-Child Appointments in a Primary Care Setting: Retrospective Comparison Study.

Background: Web-booking of flights, hotels, and sports events has become commonplace in the travel and entertainment industry, but self-scheduling of health care appointments on the web is not yet widely used. An electronic health record that integrates appointment scheduling and patient web-based access to medical records creates an opportunity for patient self-scheduling. The Mayo Clinic developed and implemented a feature in its Patient Online Services (POS) web and mobile platform that allows software-managed self-scheduling of well-child visits.

Interprofessional Simulation to Improve the Understanding of Obstetric Sepsis.

Sepsis parameters are not well defined for the obstetric population, which can result in delayed recognition. The escape room-based simulation sought to improve obstetric providers' and nurses' understanding, identification, and timely treatment of maternal sepsis. Participants expressed interest and enthusiasm in using this learning style to improve care of the sepsis patient.

A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours?

Background: Patient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours.

Objective: This study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours.

Is a switch to a different electronic health record associated with a change in patient satisfaction?

Objective: Financial impacts associated with a switch to a different electronic health record (EHR) have been documented. Less attention has been focused on the patient response to an EHR switch. The Mayo Clinic was involved in an EHR switch that occurred at 6 different locations and with 4 different "go-live" dates.

Frequency of and Factors Associated with Care Partner Proxy Interaction with Health Care Teams Using Patient Portal Accounts.

Proxies can communicate with health care teams through patient portals either by using proxy login credentials or a patient's login credentials. The frequency of proxies using patient login credentials is unknown. A random selection of 3,000 portal messages sent in through adult patients' own portal account was reviewed for indicators (referring to the patient in the third person) that someone other than the patient was using the patient portal account.

Patient Satisfaction With Providers: Do Patient Surveys Give Enough Information to Help Providers Improve Specific Behaviors.

Background: Patient satisfaction surveys ask patients specific questions about provider behavior such as whether they were satisfied with the provider's instructions about medications or time spent with the patient. It's unclear how responses to these surveys can help providers focus on specific behaviors to improve.

Methods: In a primary care setting, we analyzed Press Ganey patient experience survey responses.

Primary Care Provider Continuity Is Associated With Improved Preventive Service Ordering During Brief Visits for Acute Symptoms.

Background: If a patient presents for an acute care visit and sees their assigned primary care provider (PCP), they may be more likely to receive preventive and other services than a patient not seeing their assigned PCP.

Methods: After exclusion of 2 visits with insufficient information, we reviewed 98 consecutive, outpatient internal medicine 15-minute acute care visits comparing patients seeing their assigned PCP with those seeing a non-PCP provider. The primary outcome, preventive service ordering, was measured in 2 ways: percentage of patient visits with preventive service ordered and the total number of preventive services ordered as a proportion of all preventive service items due for each entire cohort.

Evaluating diverse electronic consultation programs with a common framework.

Background: Electronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth.

Population health challenges in primary care: What are the unfinished tasks and who should do them?

Background: There are numerous recommendations from expert sources that help guide primary care providers in cancer screening, infectious disease screening, metabolic screening, monitoring of drug levels, and chronic disease management. Little is known about the potential effort needed for a healthcare system to address these recommendations, or the patient effort needed to complete the recommendations.

Methods: For 73 recommended population healthcare items, we examined each of 28,742 patients in a primary care internal medicine practice to determine whether they were up-to-date on recommended screening, immunizations, counseling, and chronic disease management goals.

What Can Apologies in the Electronic Health Record Tell Us About Health Care Quality, Processes, and Safety?

Introduction: Apologizing to patients is an encouraged practice, yet little is known about how and why providers apologize and what insights apologies could provide in improving quality and safety.

Objective: The aim of the study was to determine whether provider apologies in the electronic health record could identify patient safety concerns and opportunities for improvement.

Methods: After performing a free-text search, we randomly selected 100 clinical notes from 1685 available containing terminology related to apology.

Do primary care providers who prescribe more opioids have higher patient panel satisfaction scores?

Objectives: Opioid prescribing in the United States has tripled since 1999. At the same time, there has been increasing attention to patient satisfaction. It has been suggested that providers concerned about patient satisfaction may be more likely to treat pain with opioids.

Telephone triage utilization among patients with limited English proficiency.

Background: Communication between patients with limited English proficiency (LEP) and telephone triage services has not been previously explored. The purpose of this study was to determine the utilization characteristics of a primary care triage call center by patients with LEP.

Methods: This was a retrospective cohort study of the utilization of a computer-aided, nurse-led telephone triage system by English proficiency status of patients empaneled to a large primary care practice network in the Midwest United States.

Uses of Mobile Device Digital Photography of Dermatologic Conditions in Primary Care.

Background: PhotoExam is a mobile app that incorporates digital photographs into the electronic health record (EHR) using iPhone operating system (iOS, Apple Inc)-based mobile devices.

Objective: The aim of this study was to describe usage patterns of PhotoExam in primary care and to assess clinician-level factors that influence the use of the PhotoExam app for teledermatology (TD) purposes.

Methods: Retrospective record review of primary care patients who had one or more photos taken with the PhotoExam app between February 16, 2015 to February 29, 2016 were reviewed for 30-day outcomes for rates of dermatology consult request, mode of dermatology consultation (curbside phone consult, eConsult, and in-person consult), specialty and training level of clinician using the app, performance of skin biopsy, and final pathological diagnosis (benign vs malignant).