What's Holding Back Online Appointment Booking?

  • Written By: Donatello Bianco
  • Published: May 1 2009


Have you ever asked yourself why you can use the Internet to book a flight, a hotel room, or even a seat at the theatre, but if you need to make an appointment with your doctor, you have to do it by phone? Do you ever find yourself on a Sunday morning or Tuesday evening wanting to arrange a check-up, but having to wait until the doctor's office opening hours before you can make the call? And when you finally make the call, have you ever wished you had more time or options to help you make the right choice? Have you wondered how much easier making appointments could be if only we had access to a dedicated online scheduling system?

I first asked myself these questions years ago and have since asked the same questions to about a hundred doctors, hospital and clinic directors and call centre managers. And their answer is always the same: "Yes, it would be good to overcome these problems", which was often followed by "but it's complicated" or "it's still too early".

Having been involved in several successful patient relationship management (PRM) implementations over the last few years, I have discovered that by avoiding some simple mistakes, an appointment scheduling system can actually be significantly less complex than generally perceived within the health industry. And it is certainly not too early, by any means, to implement one.

With a little effort, any hospital, clinic, doctor's office, or individual doctor can save a considerable amount of its own and its patients' time, make its services easy to use, and reduce non-attendance significantly.

Above all, by allowing patients to book their own appointments online, a new channel of communication can be exploited by both the patient and doctor to better manage their relationship and help make patients feel more involved. Follow-up reminders can be sent out, for example, as well as other important notifications, and new areas of patient-doctor interaction can be explored.

Working side-by-side with several health establishments to analyse obstacles and find solutions, I have had the chance to interview dozens of health care experts and I have noticed that most of the objections to online appointment scheduling fall into two main categories: cultural barriers and technological barriers. As you might imagine, it is the cultural barriers which are always the biggest challenge. Once they are overcome, the right technological solution can always then be found.

If you are thinking about adopting an online appointment scheduling system, the following paragraphs will give you some useful tips to address both the real and the imagined problems.

Obstacle 1: Cultural Barriers

It 's too complex. We're too complex. They're not ready. We're not ready …

Cultural barriers are almost always the result of false myths and common misconceptions, which can often be hard to shake. A good way to confront them is to single them out and analyze them one by one, as follows:

  1. "Online Booking is too cold and impersonal."

    An apparently widespread myth is that booking appointments over the Internet will lead to a dehumanization of health service and weaken the relationship between patient and doctor. Actually, Internet scheduling complements traditional methods of booking appointments by simply providing an additional way to perform the same tasks. Providing more choice cannot make a service worse, surely! Look at online banking. The important thing to realize is that with online appointment scheduling, we can still maintain the human element of our relationship with our doctor in the same way that we can still arrange a meeting with our bank manager while making online transfers. Our aim is to make the appointment as simple, efficient, and effective as possible, and in fact to enhance the relationship between patient and doctor, rather than to replace it.

  2. "Our patients don't know how to use Internet."

    The number of Internet users worldwide has surpassed one billion and is increasing by 18% each year. In developed countries, Internet penetration has reached 50 percent, and in Asia, the Middle East, and Latin America the average penetration rate is around 20 percent and rapidly increasing. In short, it can be assumed that any health care provider can count among its patients a significant proportion of Internet users.

  3. "Most of our patients are elderly."

    In many areas of health care, naturally most of the patients are elderly. In most developed countries, however, the percentage of elderly people that use the Internet ranges from 15 percent to 35 percent, and usership is always on the rise, with more and more elderly people learning to use the Internet to manage their free time.

  4. "Patients may not know how to decide what to book."

    This is one objection in which there is some truth. There will always be appointments whose particular nature requires that they be scheduled and assigned over the phone or while the doctor is at the doctor's office or clinic. But we must remember that the Internet is a tool that complements, not replaces the traditional methods. I advise keeping the options simple for online booking, just as for other reservations. If I want to book a room at hotel in the centre of Rome, I can do so online, but if I want to have my breakfast served on the balcony of an apartment overlooking the Colosseum, it would probably be more sensible to use the phone.

  5. "Online booking is unreliable."

    This is one of the most common fears about online booking, and also one of the most invalid: that bookings may not be registered correctly when done online, and that patients may feel less obliged to attend. In all the projects that I have followed, not once has there been any indication that traditional booking methods (by phone and at the doctor's office) are more reliable than online booking. On the contrary, online booking includes devices by which one can confirm and guarantee one's appointment, something inapplicable to telephone bookings. For example,

    Controlled Access: For several clinics, during the first phase of implementation, we temporarily restricted the service to existing patients until the staff at the clinic had become accustomed to the new system. Restricting access in this way should only be considered a temporary measure, however, as it prevents the opportunity to attract new patients.

    Password by text message: In order to make a first-time patient ‘s booking more trustable, other techniques can be used, such as acquiring the patient's mobile phone number as a prerequisite of registration and then sending the password only to that number.

    Credit Card: In many countries, mainly in the private sector, it is common practice to request someone's credit card details in order to guarantee a booking. If the client misses the appointment, some or all of the corresponding cost is debited from the card.

    Booking limitations: Another technique is to limit the number of online bookings that a patient can make, or restrict access by new patients to the last session of the day, thereby ensuring that if the patient does not show up, the doctor doesn't have to waste any time.

    Reminders: One tool that has always proved useful to both doctor and patient is the text message or voicemail reminder, which will notify you of an impending appointment at whatever time you choose.

In all of these cases, my advice is to constantly monitor the daily percentage of missed appointments for each booking method used. The results will help you to improve reliability and accessibility.

Obstacle 2: Technological Barriers

In addition to cultural barriers, technology could be perceived as a limiting factor and therefore is often cited as excuse to delay or postpone patient scheduling innovation projects. The analysis of following statements should prove how false is this perception.

  1. "My software is not equipped for this, and development costs would be too high."

    This objection held true until a few years ago. Even though the great majority of hospital IT systems still do not offer this opportunity , it is equally true that there are companies specializing in providing online scheduling systems as a service, payable generally on a monthly basis and calculated according to the number of bookable health care professionals there are.

    When deciding between these services, I would advise choosing one that already has the tools needed to synchronize the service with your existing software.

  2. "I don't use an electronic diary or I don't have a web site"

    Practically all of the companies providing online appointment services also provide an online electronic diary, and for those who need it, a basic web site. By searching "online agenda for health care" on Google, you will find providers with an online scheduling system connected to a medical agenda, and you can choose one that best meets your needs.


Online medical appointment scheduling is the ideal starting point for a PRM system. It allows you to reduce internal costs, increase client satisfaction, and develop a dynamic community of patients with whom to communicate and try out new services.

As we have seen, the objections which are responsible for hindering its progress in the marketplace are largely cultural and substantially unfounded. The technology is ready and available and the costs are affordable. What are we waiting for?

About Donatello Bianco

Donatello Bianco is an expert of online services that improve the relationship with clients and employees. In the last 15 years, as consultant, product manager, marketing director, master professor, and recently as entrepreneur he met thousands of professionals working for hundreds of organizations in more than 20 countries, exchanging ideas and collecting experiences. He spent his last 5 years focusing his research on new online services for patients. At the moment he is co-founder and CEO of tuOtempO, a patient relationship management company, and is an e-health consultant, and a customer relationship management (CRM) professor for the Stogea Master at Bologna.

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