What if booking clinical appointments looked more like booking airline tickets?
See specification.md for API requirements and details.
| Status |
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| Draft proposal for discussion |
"SMART Scheduling Links" is a standards-based specification enabling patients to:
- find appointment slots using an appointment booking tool of their choice, searching by geography, specialty, health system, etc
- follow a deep link into the provider's booking portal, to book a specific slot
- complete a booking, e.g., by providing details, answering questions, or submitting referral documentation
We are parsimonious in our use of standards, so that:
- step 1 is standardized with FHIR Slot Discovery; then
- step 2 is standardized with HTTPS deep-linking conventions; meanwhile
- step 3 requires no standardization, enabling flexible and provider-specific rules to govern the completion of the booking process. (To be clear, many standards can facilitate step 3, but they're out of scope for SMART Scheduling Links.)
This specification defines three functional roles:
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Slot Discovery Client: the booking tool of a patient's choice. This system discoverys appointment slots on a patient's behalf, and helps the patient choose the best slots to book (e.g., by evaluating trade-offs of travel distance or wait time).
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Slot Publisher: the API service offered by a healthcare provider, advertising available slots. Critically, advertising a slot should be low-risk, since the mere fact that a slot is advertised does not guarantee that any given patient will be allowed to book the slot; instead, sophisticated rules can be implemented by the...
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Provider Booking Portal: the UI service offered by a healthcare provider, enabling a user to book a selected slot. This is the place where provider-specific rules can be implemented, e.g. to ensure that patients booking a specialty appointment are appropriate candidates for that specialist's care. (In many implementations, this UI will be housed within a general-purpose provider-hosted patient portal.)
Examining the SMART Scheduling Links workflow described above, there are some potential user-experience challenges:
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After the hand-off from a Slot Discovery Client into a healthcare provider's system, the user might have to sign into the healthcare provider's system, or create a new account; and might have to answer all sorts of provider-specific questions in order to complete a booking.
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Appointment slot data might become stale, so that by the time a patient signs into the provider's system,
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Once an appointment booking is completed, the Slot Discovery Client might not have an easy way to learn about the details of the booking (e.g., was it successful; what is the specific location and timing).
In other words, compared with a deeply-integrated scheduling paradigm where a booking tool could guide the user through every step of the process, SMART Scheduling Links provides a more loosely-coupled user experience. But we have strong evidence that this is a viable UX trade-off, because it works just like a very familiar and highly successful booking system...
Cross-industry standards analogies can sometimes be misleading -- but to build up an intuition, it's worth comparing the SMART Scheduling Links workflow with the consumer airline booking experience. Briefly: the Slot Discovery Client plays the same role as a travel booking tool like KAYAK or Hipmunk. These systems help their users search for relevant options across multiple service providers, and help users evaluate trade-offs among these options. Once the user makes a selection, a deep link takes them to a service provider to complete the workflow. The Provider Booking Portal plays the same role as an airline like United or Delta. These systems manage user accounts and enable a booking-completion workflow. They also serve as gatekeepers, e.g. to collect data about a user's background as well as identifiers such as a Known Traveler Number or redress number. They can "call off" the workflow at any point (e.g., if a user is unable to provide the required information, or if a previously-available slot has been booked by another user).
This pattern works well in airline booking, and could dramatically reduce the difficulty of healthcare appointment booking.
The 2017 Argonaut Scheduling IG provides detailed specifications for scheduling appointments, but has not seen broad adoption. That specification defines a deep integration pattern where a third-party client can create new Patient resources within a server and can fully book an appointment slot for its users. There are two key challenges that have limited adoption of this IG:
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A strong degree of trust is required between the third-party app and the EHR system, since the app is allowed to directly manipulate the state of the EHR.
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Providers have no way to set rules/expectations about which patients are good candidates for a given slot -- which means that specialists are unwilling to open up scheduling. The issues is that, for example, a neuromuscular specialist needs to ensure that her patients actually have a relevant diagnosis and have been through suitable pre-specialty workup. The relevant questions and up-front data-gathering are highly specialized, and deep integration of scheduling provides no way to collect and assess these details before booking a slot.
SMART Scheduling Links provides a lightweight complement to the 2017 Argonaut Scheduling IG. It addresses real-world adoption challenges by providing a simple, familiar user experience -- with a very small standards footprint.