title: Adoption, use, and impact of e-booking in private medical practices: mixed-methods evaluation of a two-year showcase project in Canada.
abstract: BACKGROUND
  Managing appointments in private medical practices and ambulatory care settings is a complex process. Various strategies to reduce missed appointments can be implemented. E-booking systems, which allow patients to schedule and manage medical appointments online, represents such a strategy. To better support clinicians seeking to offer an e-booking service to their patients, health authorities in Canada recently invested in a showcase project involving six private medical clinics.
  
  
  OBJECTIVE
  The objectives pursued in this study were threefold: (1) to measure adoption and use of the e-booking system in each of the clinics over a 2-year period, (2) to assess patients' perceptions regarding the characteristics and benefits of using the system, and (3) to measure the impact of the e-booking system on the number of missed appointments in each clinic.
  
  
  METHODS
  A mixed-methods approach was adopted in this study. We first extracted and analyzed raw data from the e-booking system deployed in each of the medical practices to monitor adoption and use of the system over time and to assess the impact of the system on the number of missed appointments. Second, we conducted a Web-based survey of patients' perceptions in the spring of 2013.
  
  
  RESULTS
  The patients and physicians targeted by this showcase project showed a growing interest in the e-booking system as the number of users, time slots made available by physicians, and online appointments grew steadily over time. The great majority of patients said that they appreciated the system mainly because of the benefits they derived from it, namely, scheduling flexibility, time savings, and automated reminders that prevented forgotten appointments. Importantly, our findings suggest that the system's automated reminders help significantly reduce the number of missed appointments.
  
  
  CONCLUSIONS
  E-booking systems seem to represent a win-win solution for patients and physicians in private medical practices. We encourage researchers to replicate and extend our work in other primary care settings in order to test the generalizability of our findings.
authors.affiliation: HEC Montreal, Montreal, QC, Canada. guy.pare@hec.ca.
authors.forename: Guy
authors.identifier: http://orcid.org/0000-0001-7425-1994
authors.initials: G
authors.lastname: Paré
authors.forename: Marie-Claude
authors.identifier: http://orcid.org/0000-0003-1713-1018
authors.initials: MC
authors.lastname: Trudel
authors.forename: Pascal
authors.identifier: http://orcid.org/0000-0001-6516-2981
authors.initials: P
authors.lastname: Forget
keywords: e-booking; medical practices; missed appointments; mixed-methods evaluative study; primary care