One of the most difficult management issues in outpatient care is the making certain that patients follow through on recommended or scheduled studies, or future evaluations. Also, it is the following up with a patient to whom you have given a target for smoking cessation, or other behavior modification to see if they are succeeding or have succeeded.  Many efforts have been made to create a tool for managing this complex problem over a large population.

In 1998, SETMA adopted NextGen@ EMR, which has Microsoft Outlook embedded.  As we considered how to solve the above, it occurred to us that we could use the EMR and Outlook to create an Electronic Tickler File.  Because Microsoft Outlook allows delay of the delivery of an e-mail and actually to specify the time and date for that delay, it became obvious that we could use this function as an Electronic Tickler File. 

SETMA uses the Electronic Tickler File in many applications:

1. Smoking Cessation – Part of SETMA’s LESS Initiative (see Less Initiative for details) includes smoking cessation.  Typically, when a patient agrees to stop smoking, we advise them that we will call them in one month to see if they have succeeded, or are succeeding.  In order to fulfill this promised call, we complete an electronic tickler file and schedule it for delivery one month hence.  Patients are always surprised when we do call them.
2. Follow-up calls after a clinic visit – For selected patients who would benefit from a follow-up contact before their next visit, we use a Clinic Follow-up call template (see Follow-up Call Tutorial for details) to initiate a call and we sent it to our Follow-up Call Nurse for the date and time on which we wish for them to be called.  Once the patient is called, the follow-up call template is returned to the provider with the patient’s responses.
3. Follow-up call after a hospital inpatient or emergency department discharge – All patients discharged from the hospital receive a follow-up call.  At the time of discharge and as part of the discharge process, a Follow-up Call template is completed and is scheduled for delivery to our Follow-up Call Nurse, the day following discharge.  Once the patient is called, the template is forwarded to the attending physician so that he/she can know how the patient is after leaving the hospital.
4. When we tell a patient they need a follow-up mammogram, colonoscopy, EGD, etc., regardless of the interval, even five years, we create an electronic tickler file which at the appropriate time, even if it is 2015, is delivered to the provider and follow-up clerk who checks to make certain the procedure, test, evaluation, or other point of care has been done.  If it has, the provider is notified; if it has not been done, it is scheduled and the provider is notified.

The following tutorial describes how to create an electronic tickler file.