The Positive Effect of an Online Appointment Portal on a Breast Cancer Screening Program

Abstract

Background The adoption of web-based appointment methods by health care systems is increasing.

Objectives This study primarily aimed to evaluate in the setting of an organized breast cancer screening program the actual usage of an online appointment portal by the target population, i.e., how the online tool was used (type and timing of the actions performed) and by whom (users' characteristics); the effect of coronavirus disease 2019 (COVID-19) on its usage was also investigated. The effect of adopting this tool on the attendance to breast cancer screening was contextually investigated.

Methods Electronic data records of 75,903 women (45–74 years old, residing in the territory of Bologna Local Health Authority) were retrospectively reviewed.

Results In total, 12.4% of women logged into the online portal at least once. Most of them (79.9%) rescheduled, 15.7% viewed, and 4.4% cancelled their own appointment. In addition, 40.6% of all rescheduling actions were performed by the online portal; the remaining was performed by the toll-free number/dedicated email address. The highest peak (13.8%) of web accesses was registered at 10 a.m. Monday to Friday, when the toll-free number service is available. Percentages of portal usage were higher: (1) among the younger women, of Italian nationality, and for the first time invited to mammographic screening (p < 0.0001), and (2) in the pandemic period versus the prepandemic period (12.5 vs. 8.6%, respectively; p < 0.001). Finally, when compared to not using, the online portal usage led to an overall reduction in the no-show rate of almost 20% (p < 0.0001).

Conclusion The action mainly performed by using the online appointment portal was the appointment rescheduling. The usage of this tool had a positive effect on the no-show rate and it can be speculated that has led to a reduction of the request load to be handled by the center's screening staff. Finally, this study confirmed that the COVID-19 pandemic boosted the use of digital technologies.

Keywords

organized breast cancer screening - online appointment portal - appointment scheduling - no-show rate - COVID−19 pandemic

Protection of Human and Animal Subjects

The study was approved by the Ethical Committee of the LHA of Bologna on January 21, 2021 (Prot. No. 47-2021-OSS-AUSLBO). Considering the retrospective nature of the study, which was based on women electronic data records reviewing, collection of informed consent was not required.

Publication History

Received: 09 February 2023

Accepted: 05 May 2023

Article published online:
09 August 2023

• References

• 1 Sung H, Ferlay J, Siegel RL. et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (03) 209-249
• 2 Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L. U.S. Preventive Services Task Force. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med 2009; 151 (10) 727-737 , W237-42
• 3 Harris R, Yeatts J, Kinsinger L. Breast cancer screening for women ages 50 to 69 years a systematic review of observational evidence. Prev Med 2011; 53 (03) 108-114
• 4 Catarino RR, Vassilakos PP, Royannez-Drevard II. et al. Barriers to cervical cancer screening in Geneva (DEPIST Study). J Low Genit Tract Dis 2016; 20 (02) 135-138
• 5 Young B, Bedford L, Kendrick D, Vedhara K, Robertson JFR, das Nair R. Factors influencing the decision to attend screening for cancer in the UK: a meta-ethnography of qualitative research. J Public Health (Oxf) 2018; 40 (02) 315-339
• 6 Conroy M, Powell M, Suelzer E. et al. Electronic medical record-based electronic messaging among patients with breast cancer: a systematic review. Appl Clin Inform 2023; 14 (01) 134-143
• 7 Steitz BD, Unertl KM, Levy MA. An analysis of electronic health record work to manage asynchronous clinical messages among breast cancer care teams. Appl Clin Inform 2021; 12 (04) 877-887
• 8 Miles RC, Hippe DS, Elmore JG, Wang CL, Payne TH, Lee CI. Patient access to online radiology reports: frequency and sociodemographic characteristics associated with use. Acad Radiol 2016; 23 (09) 1162-1169
• 9 Beal LL, Kolman JM, Jones SL, Khleif A, Menser T. Quantifying patient portal use: systematic review of utilization metrics. J Med Internet Res 2021; 23 (02) e23493
• 10 Balthazar P, Narayan AK, Reid N, Miles RC, Flores E. effect of sociodemographic factors on utilization of an online patient portal to self-schedule screening mammography: a cross-sectional study. J Am Coll Radiol 2022; 19 (07) 866-873
• 11 North F, Nelson EM, Buss RJ, Majerus RJ, Thompson MC, Crum BA. The effect of automated mammogram orders paired with electronic invitations to self-schedule on mammogram scheduling outcomes: observational cohort comparison. JMIR Med Inform 2021; 9 (12) e27072
• 12 De' R, Pandey N, Pal A. Impact of digital surge during Covid-19 pandemic: a viewpoint on research and practice. Int J Inf Manage 2020; 55: 102171
• 13 Mandrik O, Tolma E, Zielonke N. et al. Systematic reviews as a “lens of evidence”: determinants of participation in breast cancer screening. J Med Screen 2021; 28 (02) 70-79
• 14 Zhao P, Yoo I, Lavoie J, Lavoie BJ, Simoes E. Web-based medical appointment systems: a systematic review. J Med Internet Res 2017; 19 (04) e134
• 15 Ryan M, Waller J, Marlow LAV. Could changing invitation and booking processes help women translate their cervical screening intentions into action? A population-based survey of women's preferences in Great Britain. BMJ Open 2019; 9 (07) e028134
• 16 Ryan M, Marlow L, Forster A, Ruwende J, Waller J. Offering an app to book cervical screening appointments: a service evaluation. J Med Screen 2020; 27 (02) 85-89
• 17 Yanovsky RL, Das S. Patient-initiated online appointment scheduling: pilot program at an urban academic dermatology practice. J Am Acad Dermatol 2020; 83 (05) 1479-1481
• 18 Perlangeli V, Musti MA, Ferretti F. et al. Profilo di salute. Azienda USL di Bologna. Accessed April 5, 2023 at: https://www.ausl.bologna.it/servt/dipt/dsp/trasp/informazioni-ambientali/stato-della-salute-e-della-sicurezza-umana/profilo-di-salute-2022a.pdf/view
• 19 Parmar V, Large A, Madden C, Das V. The online outpatient booking system ‘Choose and Book’ improves attendance rates at an audiology clinic: a comparative audit. Inform Prim Care 2009; 17 (03) 183-186
• 20 Siddiqui Z, Rashid R. Cancellations and patient access to physicians: ZocDoc and the evolution of e-medicine. Dermatol Online J 2013; 19 (04) 14
• 21 Lowes R. Let patients book their own appointments?. Med Econ 2006; 83 (11) 27-28
• 22 Friedman JP. Internet patient scheduling in real-life practice. J Med Pract Manage 2004; 20 (01) 13-15
• 23 Antonio MG, Petrovskaya O, Lau F. The state of evidence in patient portals: umbrella review. J Med Internet Res 2020; 22 (11) e23851
• 24 Huang J, Zuniga P. Effective cancellation policy to reduce the negative impact of patient no-show. J Oper Res Soc 2014; 65: 610-615
• 25 Dantas LF, Fleck JL, Cyrino Oliveira FL, Hamacher S. No-shows in appointment scheduling - a systematic literature review. Health Policy 2018; 122 (04) 412-421
• 26 Chang E, Blondon K, Lyles CR, Jordan L, Ralston JD. Racial/ethnic variation in devices used to access patient portals. Am J Manag Care 2018; 24 (01) e1-e8
• 27 Veinot TC, Mitchell H, Ancker JS. Good intentions are not enough: how informatics interventions can worsen inequality. J Am Med Inform Assoc 2018; 25 (08) 1080-1088
• 28 Ahmadi M, Shahrokhi SN, Khavaninzadeh M, Alipour J. Development of a mobile-based self-care application for patients with breast cancer-related lymphedema in Iran. Appl Clin Inform 2022; 13 (05) 935-948