Every appointment on a clinic's schedule carries work that never appears on a billing claim. Before the visit, someone confirms the booking and chases the pre-visit questionnaire the patient was asked to complete. After it, someone is meant to make sure the review gets booked, the result gets read and the patient hears back. In many clinics this work is spread across a texting service, a forms portal and a list kept by whoever is on the front desk that week, and none of the three knows what the others have done.
The cost is easy to underestimate because it arrives in small pieces. In January 2026, the Canadian Medical Association and the Canadian Federation of Independent Business published Losing Doctors to Desk Work, which found that physicians in Canada spend more than a full day each week on administrative tasks, nearly half of which do not require a physician's expertise, and estimated that about 20 million hours a year are lost to unnecessary red tape. Eliminating that burden, the report calculates, could free the equivalent of 9,093 full-time physicians. Some of that work is the routine traffic around each appointment, which is the subject of this article.
Confirmation Calls: Why the Patient's Reply Matters as Much as the Reminder
The evidence that reminders improve attendance is consistent. A Cochrane review published in 2013 included eight randomized trials with 6,615 participants and found that in the seven trials comparing text message reminders with no reminder at all, the texts improved attendance. When the review compared text messages with phone call reminders, the two performed about the same, and the authors rated the evidence for both findings as moderate in quality.
An earlier systematic review of 29 studies in the Journal of Telemedicine and Telecare reached a similar conclusion for hospital appointments. Phone calls made by staff reduced non-attendance by 8.3 percentage points on average, and automated text messages or calls by 8.9 points. Measured against each study's starting rate, the authors found staff calls more effective, cutting non-attendance by 39 percent against 29 percent, although in absolute terms the two approaches were close. Both reviews are more than a decade old.
What these studies cannot measure is what happens to the patient's answer. A patient who replies that they cannot come on Thursday has handed the clinic an open slot, but the slot is only worth something if the reply reaches the schedule while there is still time to offer it to someone else. If the reply sits in a separate messaging inbox until the afternoon, the slot usually goes unused. We cover the causes of missed appointments and the tactics that reduce them in our guide to reducing no-shows.
Confirming Surgical and Procedure Bookings
Specialist and surgical practices, whose bookings usually begin with a referral that has to be accepted first, run a different kind of confirmation. Staff choose a date with the surgeon and the operating room, then have to reach the patient to confirm it, go over the instructions the clinic has written for the day, and find out early if the patient cannot attend. A missed confirmation here can cost an operating room slot rather than a fifteen-minute appointment.
At three surgical services in Kingston, Ontario, researchers from Queen's University reviewed 19,141 elective cases scheduled from 2005 to 2009 and found that 1,544 of them, or 8.07 percent, were cancelled on the day of surgery. Writing in the Canadian Urological Association Journal, they reported that process problems, such as scheduling errors, accounted for 58.5 percent of cancellations, by far the most common cause. They recommended that hospitals monitor every operating room cancellation as an adverse incident. The data are old, and the operating room is the hospital's to run, but scheduling errors, the study's own example of a process failure, can begin in the surgeon's office.
A confirmation call that reaches the patient a week ahead, records the answer and flags a problem to the booking coordinator the same day is a step the clinic can take on its own. It only works if the coordinator sees the result without having to go and look for it.
Pre-Visit Questionnaires Help Only When the Answers Reach the Chart
An American Medical Association guide to pre-visit planning describes practices that email patients a link to a pre-appointment questionnaire, with the responses flowing into the next day's visit note. The guide also suggests letting patients answer the questions usually asked during rooming, such as a depression screen, a pain assessment or smoking status. The AMA estimates that pre-visit planning often saves 30 minutes of physician time and 30 minutes of staff time each day, which it values at about US$26,400 a year for a practice open 220 days. That figure is the AMA's own estimate rather than the result of a trial.
Patients do complete these forms. In a 2024 implementation report in JMIR Medical Informatics, orthopaedic departments at two Dutch hospitals invited 5,321 patients to complete an online history-taking questionnaire before their consultation, and 4,932 of them, or 92.7 percent, finished it.
We could not find a randomized trial in primary care that measured how much physician time an electronic pre-visit questionnaire saves, so any vendor promising a precise number is ahead of the evidence. What the AMA guide and the Dutch report share is a design choice: the answers were in the record before the patient sat down. The physician's own review of the chart before a visit is a separate job, which we cover in our article on pre-visit chart summaries. A questionnaire that arrives as a PDF in a shared inbox, or sits in a portal the physician never opens during the visit, adds a step to the day instead of removing one. Keep the form short, ask only what the physician will use, and treat the answers as the personal health information they are.
A Pre-Visit Questionnaire Template to Adapt
A useful starting point covers the questions that otherwise take up the first minutes of a visit. Adapt it with the physicians who will read the answers, and remove anything they will not use.
- What is the main reason for this visit, in your own words?
- Has anything changed since your last visit or since you were referred?
- Which medications do you take now, including over-the-counter drugs and supplements, and has anything changed?
- Do you have any allergies, and what reaction did you have?
- Have you been to a hospital, an emergency department or a walk-in clinic since your last visit?
- Have you had tests or imaging done elsewhere, and where?
- The screening questions your physicians ask routinely, such as the depression, pain or smoking questions the AMA guide mentions
- Are your phone number, address and pharmacy still correct?
For a first visit with a specialist, add the referring physician's name and whether the patient has imaging or reports to bring. If a validated screening tool is part of the questionnaire, use it as published rather than rewording its questions.
Patient Follow-Up After an Appointment: Where Results and Reviews Slip
The work after a visit is where the consequences of a missed step are most serious. A review by Joanne Callen and colleagues summarizes their earlier systematic review of 19 studies, which found that between 6.8 and 62 percent of laboratory results in ambulatory care were not followed up, along with between 1.0 and 35.7 percent of radiology results. The authors also report that hybrid records, part paper and part electronic, are associated with more errors and duplication than fully electronic systems.
The Canadian Medical Protective Association has seen the outcome of those gaps in its own files. In an analysis published in December 2024, it reviewed 268 College and legal cases closed between 2019 and 2023 that involved test follow-up by office-based family physicians. Patients were harmed in 250 of them, and about one in five involved severe harm or death. Documentation was a factor in 47 percent of cases and communication problems with patients or families in 39 percent. Family physicians make up 35 percent of CMPA members but accounted for 45 percent of the complaints and civil actions about test follow-up that it reviewed for those years. Among the CMPA's recommendations are reminders that flag results not yet received, results not yet shared with the patient, and missed appointments or outstanding follow-up.
Follow-up is broader than test results. It includes the review appointment the patient was told to book, the check-in a few days after a procedure, and the specialist report that needs a response. It differs from recall, which works from a registry of patients due for screening or chronic disease care, a subject we cover in our article on primary care patient recall. A follow-up starts from something that happened in a particular visit, which is why it gets lost when the visit record and the follow-up list live in different places.
Why Confirmations, Questionnaires and Follow-Ups Need One Connected Record
Canadian physicians have largely gone digital inside their own practices. In the 2024 National Survey of Canadian Physicians, run by Canada Health Infoway and the Canadian Medical Association, 95 percent reported using electronic records for clinical documentation, up from 87 percent in 2021, yet 73 percent named system fragmentation and lack of integration as significant barriers.
Inside a single clinic, the reminder service records that a patient cancelled, the forms portal holds a completed questionnaire, and the follow-up list says a patient was called twice without an answer. Each tool did its job, and each produced something a person now has to carry into the EMR by hand. When those steps share one record instead, the cancellation reopens the slot so it can be offered to the waitlist, a patient's details reach the chart without being retyped, and the type of visit sets when the follow-up call goes out and records what the patient said. We make the broader case for this in The Point Solution Trap and our article on modular EMR strategy.
How JOUD Connects the Work Around Each Visit
JOUD runs these steps on one connection to the EMR the clinic already uses, including TELUS CHR, Accuro and OSCAR Pro in Canada and Epic in the United States, so the result of each step is written where the next one can find it.
- It sends a confirmation the moment an appointment is booked, moved or cancelled, then reminders on the schedule the clinic sets. A patient's reply confirms, cancels or reschedules the appointment in the EMR directly.
- It places outbound calls for the reasons a clinic defines, including post-visit check-ins and outstanding items. Attempts repeat on the clinic's schedule, and every outcome is recorded against the patient.
- New patients register themselves on a tablet when they arrive, and their details go straight to the chart instead of onto a clipboard someone has to key in later.
- Calls that need clinical judgment go to staff with the transcript. JOUD gives no clinical advice, and the clinic team decides which calls it handles.
Elevation Labs builds clinic operations AI for primary care and specialist clinics across Canada and the United States. If confirmations, forms and follow-ups are still running on three separate lists in your clinic, book a demo and we will walk through how they fit on one.
Frequently Asked Questions
What is a pre-visit questionnaire?
It is a short form a patient completes before an appointment, usually online, covering the reason for the visit, changes in health and medications, and any screening questions the physician uses. It saves time only when the answers reach the patient's record before the visit begins.
What should a pre-visit questionnaire include?
The reason for the visit, changes since the last one, medications and allergies, recent hospital visits and outside tests, and only the screening questions the physician actually uses. The template above is a starting point. Because the answers are personal health information, collect them through a channel your privacy policy covers.
Why are surgeries cancelled on the day?
In a Queen's University review of 19,141 elective cases in Kingston, Ontario, 8.07 percent were cancelled on the day of surgery, and process problems such as scheduling errors caused 58.5 percent of those cancellations. A confirmation call made well ahead of the date gives the clinic time to catch a problem that would otherwise surface in the operating room.
Are text message reminders as effective as phone calls?
In the Cochrane review of randomized trials, text message reminders performed about as well as phone call reminders, and both improved attendance compared with no reminder. What matters as much is whether a patient's reply changes the schedule in time to fill the slot.
How is a follow-up call different from a recall call?
A recall call works from a list of patients due for screening or chronic disease care. A follow-up call starts from a specific visit, such as a review the patient was asked to book or a result that needs discussing, so it depends on the visit record and the follow-up list being connected.