At AMPATH, appointment management is not done through a dedicated appointment management system but via forms. The MOH form asks the provider to put a return date for each patient. We then have two processes for handling the future schedule. For those sites using EMR, we maintain lists of patients for each data collected via the form. In both EMR and non EMR sites, our outreach team maintains a separate manual diary for appointments. When a patient leaves the clinic, the outreach worker will record the write the persons name down on the relevant day they are to return.
This creates a few challenges for us:
The EMR does not have an easy way of updating appointments dates if a patient calls (or is called) to change the clinic date. As as result patients often appear on both the old date and new date even after a valid change.
On the manual side, it’s very tricky to make sure that all patient data is recorded. It’s easy to miss a form or a patient and not include them on the date. Additional, for a clinic with many many patients, it can be hard to find the patients in the diary and this leads to frequently failing to mark a patient has having come (making it appear like the patient missed). When patients come early or late, because it is extra work to find them, often this step is skipped and so the appointment list is no longer up to date.
In both cases, the lack of accurate appointment data leads to challenges when both figuring which patients need outreach and for reporting purposes. It is a common problem that we report a patient has LTFU even though they came to clinic simply because of missing data.
We would love to work with other organizations on the creation of an EMR module or add-on to properly support appointment scheduling and management as well as patient queueing. Something that could handle more than just a HIV related appointments would be extremely helpful. By ensuring we have accurate information on when patients did come and when they are supposed to come, we will greatly improve our processes for outreach and reporting.