TYPE Original Research

PUBLISHED 02 May 2025

DOI 10.3389/fdgth.2025.1567397

Efficient patient care in the digital

age: impact of online
appointment scheduling in a
EDITED BY
Roshan Joy Martis,
Manipal Institute of Technology Bengaluru,
India

REVIEWED BY
medical practice and a university
N.J. Patil,
Manipal Academy of Higher Education, India hospital on the “no-show”-rate
Mahesh Kumar Goyal,
Google, United States
Paola Kammrath Betancor1, Daniel Boehringer1, Jens Jordan1,2,
*CORRESPONDENCE
Michael Reich
Charlotte Lüchtenberg2, Marcus Lambeck2,
drmichaelreich@[Link] Manuel Christoph Ketterer3, Thomas Reinhard1 and
RECEIVED 27 January 2025 Michael Reich1,2*
ACCEPTED 22 April 2025
1
PUBLISHED 02 May 2025 Eye Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg,
Freiburg, Germany, 2Augenärzte am Städel, Frankfurt am Main, Germany, 3Department of
CITATION Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of
Kammrath Betancor P, Boehringer D, Jordan J, Freiburg, Freiburg, Germany
Lüchtenberg C, Lambeck M, Ketterer MC,
Reinhard T and Reich M (2025) Efficient patient
care in the digital age: impact of online
Background: Online appointment scheduling (OAS) increases patient
appointment scheduling in a medical practice
and a university hospital on the “no-show”-rate.
satisfaction and enables more efficient care.
Front. Digit. Health 7:1567397. Method: A retrospective study in an ophthalmology practice and an
doi: 10.3389/fdgth.2025.1567397 ophthalmology university hospital. Over 20 months, all booked practice-
COPYRIGHT appointments before and after OAS implementation were recorded. Rates of
© 2025 Kammrath Betancor, Boehringer, cancellations/rescheduling and unexcused absences (“no-shows”) were
Jordan, Lüchtenberg, Lambeck, Ketterer,
compared. During the same period, OAS usage, no-show rates, and related
Reinhard and Reich. This is an open-access
article distributed under the terms of the factors were analyzed in the hospital.
Creative Commons Attribution License (CC Results: During the observation period, 16,894 appointments were booked in
BY). The use, distribution or reproduction in
the practice and 81,173 in the hospital. In both, the rate of appointments
other forums is permitted, provided the
original author(s) and the copyright owner(s) scheduled via OAS increased continuously, with an average rate of 22.8% in
are credited and that the original publication in the practice and 7.2% in the hospital. The no-show rate in the practice was
this journal is cited, in accordance with
lower for appointments booked online compared to those booked offline
accepted academic practice. No use,
distribution or reproduction is permitted (median (
x) 1.8% vs. 5.9%, p < 0.0001), whereas it was higher in the hospital (x¯
which does not comply with these terms. 14.3% vs. 11.2%, p < 0.0001). Regular consultations and SMS reminders were
most effective in reducing no-shows in the hospital (Odds Ratio (OR) 0.40 and
OR 0.93). The implementation of OAS in the practice reduced the rates of
unused appointments (
x 22.7% vs. 10.3%, p < 0.0001) and never booked
appointments (
x 8.6% vs. 1.6%, p < 0.0001), thereby increasing the utilization of
available appointments ( p < 0.0001).
Conclusion: OAS improves flexibility and resource use in the practice. In the
hospital, SMS reminders mostly reduce no-shows, prompting development of
a comprehensive reminder model.

KEYWORDS

efficient patient care, online appointment scheduling, ophthalmology, private practice,

university hospital

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Introduction examined OAS usage patterns, no-show rates, and associated

influencing factors within a university hospital setting.
The ongoing digitalization is not only transforming our daily
life but also the healthcare sector. Online appointment
scheduling (OAS) is gaining importance, as it optimizes Methods
processes, improves patient satisfaction, and facilitates better
resource utilization (1, 2). Study design
Physician practices are typically reachable by phone only
during office hours, which ties up personnel resources, among This is a retrospective, two center observational study, conducted
other things (3). University hospitals, on the other hand, are in a private ophthalmology practice in collaboration with an
open 24/7 and often experience high patient volumes with ophthalmology university hospital. Following a written request to
occasionally long waiting times. Traditional appointment the Ethics Committee of the responsible State Medical Association
scheduling presents significant operational challenges: reliance on of Hessen, Germany, prior to the study initiation, the committee
telephone communication restricts access to office hours, manual informed us that, in accordance with § 15 Abs. 1 BO, an ethics
coordination consumes considerable personnel resources leading vote and written informed consent from participating subjects or
to potential bottlenecks and errors, and inflexibility often results their legally authorized representatives are not required for this
in long patient waiting times and inefficient use of clinical slots study (ethical approval number: 2024-3837-AF), as § 15 Abs. 1 BO
(3, 4). Online Appointment Scheduling (OAS) directly addresses exempts retrospective analyses of pseudonymized or anonymized
these challenges by providing patients with 24/7 booking routine healthcare data under these conditions. Under the updated
accessibility, automating the scheduling process to free up staff Health Data Utilization Act (GDNG) § 6, as of 26.03.2024, legally
time, offering enhanced flexibility for patients to manage their stored data may be processed for medical research purposes.
appointments (e.g., rescheduling or cancellations), and enabling
features like automated reminders. These capabilities aim to
improve overall system efficiency, optimize resource utilization, Study population
and enhance patient satisfaction (1, 2, 5). A Canadian study
demonstrated that patients particularly value the flexibility, time The study cohort included all patients of the practice and the
savings, and automatic reminders provided by OAS, which university hospital who scheduled appointments, both online and
reduce missed appointments (5). offline, during the observation period.
Unannounced missed appointments (no-shows) place a burden
on the healthcare system, as they decrease the efficiency of
physician practices and hospitals. A Chinese study using the data Inclusion and exclusion criteria
of the outpatient department at a general hospital analyzed key
factors contributing to missed online-scheduled appointments. Of The focus of the data collection was to record all appointments
48,777 scheduled appointments, the no-show rate was 15%. No booked online and offline during the observation period to provide
correlation was found between no-shows and gender, day of the a complete representative picture of the use of the OAS system.
week, or appointment fees, but a positive association was Therefore, all appointments were included in the study
observed with a history of missed appointments (6). A review of without exception.
105 studies including multiple types of specialties and different
types of clinics identified an average no-show rate of 23%.
Higher no-show rates were correlated with longer lead times, Online appointment scheduling practice
previous no-shows, younger patient age, lower socioeconomic
status, greater distance from the clinic, and lack of private The OAS was implemented in the practice on 01.03.2023 and is
insurance (7). managed through a commercially available program. For
In a preceding pilot study, we analyzed all online and offline competitive reasons, the name of the company is not disclosed.
booked appointments over 12 weeks in an ophthalmology The OAS calendar is integrated with the practice’s patient record
practice. Patients typically rescheduled or canceled appointments software and is also used for appointments scheduled via phone,
24–48 h in advance using OAS, allowing the practice to reassign email, or in person, ensuring that appointment overlaps are
freed-up slots, thereby increasing efficiency (8). avoided. The calendar was tailored to the practice’s office hours.
While OAS is increasingly adopted, detailed comparative Further details can be found in our pilot study (8).
analyses across different healthcare settings (private practice vs.
university hospital) within the same specialty, particularly
examining under-reported efficiency metrics alongside no-show Online appointment scheduling university
rates, remain scarce. hospital
This study aimed to analyze how OAS contributes to efficient
patient care. Specifically, we first compared the no-show rate in a The OAS system in the university hospital is self-developed.
private practice before and after implementing OAS. Second, we Patients can submit their contact information and request an

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appointment via a contact/appointment form on the ophthalmology University hospital

department’s homepage at the University Hospital Freiburg, For the the patient’s age (in years), and gender were recorded.
Germany. They are then assigned an appropriate appointment. Due Additionally, distinctions were made between various consultation
to the wide range of specialized consultations, unlike in the practice categories analyzed for no-show risk: Private consultations,
setting, patients cannot directly book their preferred appointments. Intravitreal Injection (IVI) clinic, Neuro-ophthalmology and
Each request is triaged internally by specialists to determine urgency Pediatrics (NP) clinic, and all other “regular” (general or other
or to refer the patient back to their treating ophthalmologist. subspecialty) ophthalmology consultations combined as the
Processing can take up to 7 business days. This necessary triage step, reference group.
inherent to tertiary care centers managing complex referrals and
ensuring patients reach the correct sub-specialist, contributes to the
processing time observed. Patients can also use the online form to Statistical analysis
request appointment cancellations or rescheduling, which are also
triaged internally and handled asynchronously. Responses are GraphPad PRISM (GraphPad Software, Version 8, San Diego,
communicated to patients through a web form, with a cryptographic US) was used for data analysis. For descriptive analysis median
access link sent via SMS or Quick-Response code. (x) and range was calculated. The chi-square test was employed
to compare booking behaviors between groups: appointment
cancellations/rescheduling for online vs. offline booked
SMS reminder appointments, no-shows for online vs. offline booked appointments,
and unused/never booked appointments before vs. after OAS
In the practice, patients receive an SMS reminder 24 or 48 h implementation. Significance was defined as p < 0.05.
prior to the scheduled appointment, depending on the booking For the practice, due to the economic sensitivity of the
timeframe, through the OAS system. At the university hospital, data, no distinction was made between patients with public or
SMS reminders are sent 7 days before the scheduled appointment private insurance. To assess the correlation between practice
via the self-developed OAS system. efficiency (the proportion of unused appointments) and
the rate of online-scheduled appointments, a Spearman rank
correlation was performed, and a non-linear regression analysis
Data collection was applied.
For the statistical analysis of factors associated with no-shows
Observation time in the university hospital, a multifactorial logistic regression
The data collection period extended from 01.09.2022–30.04.2024, analysis was conducted to calculate the odds ratio (OR),
allowing for a comparison before and after the implementation of including the 95% confidence interval (95% CI), for all covariates
OAS in the practice on 01.03.2023. One of the physicians has been considered together. These calculations were performed using the
working in the practice since 01.07.2022, so data prior to 01.09.2022 R system, version 4.1.3 (9).
was not representative. This period (September 2022 to February
2023) served as the crucial baseline or control period for the
practice setting, allowing for a direct before-and-after comparison to Results
assess the specific impact of OAS implementation on efficiency
metrics. While OAS was already operational in the university Demand of online appointment scheduling
hospital prior to September 2022, we collected data from the same
observation period (01.09.2022–30.04.2024) for both the practice Interest in online appointment scheduling (OAS) has been
and the hospital. This ensures a consistent timeframe for analyzing steadily increasing both in the practice and the university
trends and allows for comparison of system usage patterns and hospital (Figure 1). Of the total 12,312 appointments scheduled
outcomes (like seasonality effects on no-shows) between the two at the practice since the introduction of OAS, 22.8% (2,806
settings during the defined period. appointments) were booked online. A total of 4,582
appointments took place before the introduction of OAS from
Practice September 2022–February 2023.
In the practice, data on all scheduled appointments for three At the university hospital, where the majority of appointments
adult consultations were collected during the observation period, are directly requested by specialists, 7.2% (6,288 of 81,173
differentiated between online and offline booked appointments, appointments) were booked online.
as well as patient attendance or absence with or without
notification. Additionally, the number of appointment slots that
were never booked (meaning appointment slots that always Impact of online appointment scheduling
stayed empty), as well as the number of booked but finally and other factors on the no-show rate
unused appointments (due to rescheduling, cancellation, no-
show) that could not be filled, were recorded. A “no-show” was We analyzed the impact of booking method (online vs.
defined as an unexcused absence of a patient. offline) and, particularly in the hospital setting, other factors

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FIGURE 1
Utilization of online appointment scheduling in practice and university hospital. (A) Percentage and (B) absolute number of appointments booked via
online appointment scheduling relative to all scheduled appointments during the observation period. Line of best fit for practice (blue): Y = 0,37
X + 17,7, R 2 = 0,15; Line of best fit for university hospital (orange):: Y = 0,12 X + 13,1, R 2 = 0,24.

including seasonality (month), patient gender, patient age, Impact of SMS reminders on the no-show
use of SMS reminders, and type of specialty consultation on rate at the university hospital
no-show rates.
In the practice, the overall rate of appointments not attended as The use of SMS reminders at the university hospital increased
originally scheduled (i.e., including cancellations, rescheduling, and from 11.4% in September 2022–25.4% in April 2024 (Figure 3A).
no-shows) was higher for online bookings compared to offline This rise in SMS reminders correlated with a decrease in the no-
bookings (up to 31.7% vs. 19.4%, p < 0.0001, Figure 2A). The show rate (p = 0.0013, Figure 3B).
ability to reschedule or cancel appointments was utilized more
often for online-booked appointments compared to offline
bookings (up to 29.8% in March 2023 vs. 12.9% in March 2024, Impact of online appointment scheduling
p < 0.0001, Figure 2B). However, the no-show rate for online- on the practice’s efficiency
booked appointments was significantly lower than for offline
booked appointments (x 1.8%, range 0.8%–5.3%, vs. x 5.9%, Before the introduction of OAS at the practice, the rate of
range 4.6%–7.6%, p < 0.0001, Figure 2C). unused appointments showed clear fluctuations, with a range of
In contrast, at the university hospital, the no-show rate for 6.7% (from 17.7%–24.4%, Figure 4A), and never-scheduled
online-scheduled appointments was higher (x 14.3%, range appointments varied between 5.3% and 12.5% (Figure 4B). After
10.9%–17.5%, vs. x 11.2%, range 8.9%–12.2%, p < 0.0001, the implementation of OAS, these rates decreased significantly,
Figure 2D, OR 1.16, Figure 2E) and exhibited clear fluctuations. with a median rate of unused appointments before vs. after
From September 2022–February 2024, a slight decline in the no- implementation of 22.7% vs. 10.3%, (range 17.7%–24.4% vs.
show rate was observed (12.2% vs. 10.4%, Figure 2D). Seasonally, 7.8%–11.8%, p < 0.0001, Figure 4A) and a median rate of never-
July had the lowest no-show potential (Figure 2E), though July scheduled appointments of 8.6% vs. 1.6% (range 5.3%–12.5% vs.
was only captured once during the observation period. Male 1.1%–3.2%, p < 0.0001, Figure 4B). After implementation of OAS
patients had a higher risk of no-shows (OR 1.11, Figure 2E), the rate of unused appointments continuously further declined
while the risk decreased with increasing age (OR 0.99, (from 11.8% in April 2023–6.0% in April 2024), and the range of
Figure 2E). SMS reminders also reduced the no-show risk (OR never-scheduled appointments narrowed to 2.1% (range from
0.93, Figure 2E). The consultation of intravitreal injection (IVI) 1.1%–3.2%). March 2023 was excluded from this analysis, as the
had the lowest no-show rate of all specialty consultations, introductory phase of OAS was considered non-representative.
followed by the neuro-ophthalmology and pediatric consultation As the utilization of OAS increased, appointment occupancy
(NP), and the consultation for patients with private health rates rose, leading to improved efficiency in the practice
insurance (OR 0.40, 0.45, and 0.70, respectively, Figure 2E). (p < 0.0001, Figure 5).

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FIGURE 2
No-Show rates for online vs. Offline Booked Appointments. (A) Percentage of missed appointments, (B) percentage of canceled/rescheduled
appointments, and (C) percentage of no-shows relative to all (blue), exclusively online (green), and exclusively offline (light gray) booked
appointments in the ophthalmology practice. The vertical dark gray line marks the implementation of online appointment scheduling in the
practice. Statistical comparisons between online and offline booked appointments were made using the chi-square test. (D) Percentage of no-
shows relative to all (orange), exclusively online (green), and exclusively offline (light gray) booked appointments at the University Hospital,
Department of Ophthalmology. Statistical comparisons between online and offline booked appointments were made using the chi-square test. (E)
Statistical representation of the odds ratios (OR) for various factors associated with a no-show appointment at the University Hospital, Department
of Ophthalmology. Eleven months (light gray) are compared to July (this month is excluded from the list, as it exhibited the lowest no-show
potential). Online requests are compared to appointments scheduled by a specialist. Male patients are compared to female patients. Age is
presented relative to years of life. Appointments with SMS reminders are compared to those without reminders. Specialized consultations (Private,
NP, neuroophthalmology and pediatrics; IVI, intravitreal injections) are compared to all other regular patients.

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FIGURE 3
Impact of SMS reminders on No-show rates at the university hospital. (A) Percentage of appointments with SMS reminders relative to all scheduled
appointments during the observation period. Line of best fit: Y = 0.76 X + 12.5, R² = 0.85. (B) Correlation between the percentage of appointments with
SMS reminders and the no-show rate percentage. Spearman r = −0.67; 95% confidence interval: −0.86 to −0.31, p = 0.0013. The trend curve was
created using linear regression analysis, R² = 0.44.

Discussion healthcare facilities should offer OAS, and 22% specifically

choose practices that provide this service.
This study provides a unique comparison of OAS
implementation in two distinct ophthalmology settings—a private
practice and a university hospital—analyzing not only no-show Impact of online appointment scheduling
rates but also broader efficiency metrics like unused and never- and other factors on no-show rates
booked appointments over a substantial 20-month period.
In recent years, online appointment scheduling (OAS) has Commercially available OAS programs allow patients to easily
become an integral part of patient care (2). This study reschedule or cancel their appointments (5, 14). In practice,
demonstrates that OAS contributes to the efficient use of appointments booked online are more frequently missed
resources in the healthcare sector. (Figure 2A) or explicitly rescheduled or canceled (Figure 2B). As
described in our pilot study, cancellations or reschedulings
typically occur 24–48 h before the appointment (8). This
Increasing demand for online appointment flexibility is correlated with a lower no-show rate for online
scheduling bookings (15), enabling timely reallocation of available slots,
which is financially beneficial for medical practices (2, 16).
OAS is becoming particularly relevant in medical practices (10, Most appointments at university hospitals are requested
11), and is also increasingly being used by patients in hospitals directly by specialists for their patients. Since patients in these
(12), as illustrated in Figure 1. A survey conducted by the Digital hospital settings cannot easily cancel or reschedule appointments
Association Bitkom in November 2022 revealed that 33% of autonomously via a direct booking interface, unlike the OAS
Germans book their medical appointments online, and 34% are model used in the practice, the no-show rate for online-booked
considering doing so (13). Furthermore, 66% believe that all appointments is higher (Figures 2C,D). This difference

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FIGURE 4
Efficiency improvement through enhanced resource utilization following the Introduction of online appointment scheduling in a medical practice. (A)
Percentage of unused appointments (due to cancellations/reschedulings/no-shows/never booked appointments) and (B) specifically, the percentage
of never booked appointments relative to all available appointments. The vertical dark gray line marks the introduction of online appointment
scheduling in the practice. Statistical comparisons between the pre- and post-introduction phases were made using the chi-square test.

underscores how the specific implementation of OAS (direct Positive impact of SMS reminders on the
booking vs. request/triage system) and the level of patient no-show rate at the university hospital
autonomy significantly influence outcomes like no-show rates.
Interestingly, the lowest no-show potential, in terms of seasonality, SMS reminders are a simple tool that notify patients of
was observed in July (Figure 2E), rather than in the winter months, their upcoming appointments and have thus been shown to
as one might expect (17). Regarding specific consultations, the reduce the no-show rate in our analysis (Figure 3). Kheirkhah
consultation of intravitreal injection (IVI) at the university hospital et al. studied the prevalence, predictors, and economic
showed the lowest no-show rates, likely due to the regularity of the consequences of patient no-shows in 10 American clinics, each
consultations, typically scheduled every four weeks. Various with a different specialty. In their study, centralized telephone
studies suggest that a shorter interval between appointment reminders reduced the no-show rate only slightly, from 16.3%–
request and appointment date leads to a lower no-show rate 15.8% (21). However, a systematic review of 26 studies including
(6, 18). The observed lower risk of no-shows with increasing multiple specialties in different countries by Robotham et al.
patient age aligns with some literature suggesting younger patients revealed that patients reminded of their appointments were 23%
may have higher no-show rates, potentially reflecting different life more likely to attend (22).
priorities or stability. Appointments in the neuroophthalmology
and pediatric consultation (NP) are rarely missed, as both parents
are often present, allowing for more precise scheduling. The Positive impact of online appointment
slightly higher risk for male patients is also seen in some studies, scheduling on practice efficiency
though reasons are complex and may relate to differing healthcare
engagement patterns. Privately insured patients tend to miss The introduction of OAS, primarily through the significant
appointments less frequently, which may be attributed to a higher reduction in unused or unallocated appointments, has markedly
adherence to health-related commitments (19, 20). increased the efficiency of the medical practice presented in this

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Limitations

This study is based on data from an ophthalmology practice

and an ophthalmology university hospital. While the core
principles observed (e.g., patient demand for digital access,
impact of reminders) likely apply broadly, the magnitude of the
effects of OAS on no-show rates and efficiency might differ in
other specialties depending on patient populations, appointment
types, and specific OAS workflows. Patient cohorts from other
medical specialties may demonstrate different behaviors with
OAS due to varying demographic compositions, which may limit
the generalizability of these findings to other medical fields.
Regarding the practice data, no distinction was made between
patients with statutory or private insurance, as this information
FIGURE 5
involves sensitive business data. Additionally, no demographic
Correlation between increased efficiency and a higher utilization of data were collected. Thus, it is not possible to evaluate whether
available appointments with a growing share of online booked
patient-related factors such as gender or age have an impact on
appointments. Correlation between the percentage of
appointments booked via online appointment scheduling (Figure 1, the no-show rate.
Practice) and the percentage of unused appointments (Figure 4A). Reliance on OAS introduces vulnerabilities related to
Spearman r = −0.82; 95% confidence interval: −0.93 to −0.58,
p < 0.0001. The curve of best fit was created using nonlinear technology, including potential system outages, software
regression analysis, R² = 0.87. A hypothetical intersection at integration challenges, data privacy, and cybersecurity risks,
X = 100, Y = 2.36 was assumed. The Y-value corresponds to the
which were not evaluated in this study.
average no-show rate for online-booked appointments between
March 2023 and April 2024 (Figure 2C). Due to the specialized nature of the consultations within a single
medical specialty, it is not possible to offer OAS in a university
hospital as in a medical practice. For the same reason, patients
cannot directly reschedule or cancel their appointments.
study (Figure 4). Figure 5 highlights the positive correlation Consequently, the self-developed OAS system in the university
between efficiency improvement and the rate of online-booked hospital is used less frequently than in the medical practice. This
appointments. The reduced variability in the rate of missed or shows that simpler direct-booking OAS models are less suitable for
unused appointments following OAS implementation (Figure 4) scenarios requiring complex triage, multidisciplinary coordination,
enables more precise personnel planning, thereby lowering or specific sequences of appointments. Furthermore, due to this
staffing costs. Additionally, the automation of the appointment distinction, our data from the private ophthalmology practice and
scheduling process reduces administrative burden and costs, the university hospital cannot be fully compared on a one-to-
which are otherwise limited by telephone line capacity and one basis.
appointment schedulers (23). Comparable results have already
been observed in industries outside healthcare. For instance, in
the transportation and hospitality sectors, the use of consumer-
based online reservation systems has been shown to improve Outlook
operations (24), profitability (25), customer loyalty (26) and wait
times (27). Concerns expressed by some physicians in the The finding that SMS reminders reduce the no-show rate in the
literature regarding a potential imbalance between the costs and university hospital has prompted the development of a system in
benefits of OAS (10, 28) are unfounded based on the findings of which all patients — new and returning, regardless of whether they
this study. book appointments online or offline — will be asked at registration
if they wish to receive SMS reminders. In the medical practice,
patients who do not book their appointments online are already
Strengths of the study being offered the option of receiving SMS reminders.
Building on the observed effectiveness of SMS reminders in the
This study has several strengths, including its two-center design hospital setting, concrete next steps could include conducting
allowing direct comparison between a private practice and a interviews and surveys with diverse patient groups and healthcare
university hospital within the same specialty. The large dataset staff to gain deeper insights into the barriers (e.g., digital literacy,
collected over 20 months, encompassing periods before and after usability issues) and facilitators influencing OAS adoption,
OAS implementation in the practice, enables robust analysis of satisfaction, and impact on patient experience. Furthermore,
its impact. Furthermore, the examination of specific efficiency rigorous economic evaluations should be performed to compare
metrics like “unused” and “never booked” appointments provides the implementation and maintenance costs of OAS systems and
a more comprehensive assessment of resource utilization than integrated reminder strategies against the potential savings derived
focusing solely on no-show rates. from reduced no-show rates and improved operational efficiency.

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Conclusion Author contributions

The introduction of OAS in medical practices provides patients PK: Conceptualization, Data curation, Formal analysis,
with greater flexibility in their appointment scheduling and has led Writing – original draft, Writing – review & editing. DB:
to a reduction in no-shows, better utilization of available Conceptualization, Data curation, Formal analysis, Methodology,
appointments, and thus more efficient resource use as the Writing – review & editing. JJ: Resources, Writing – review &
proportion of online-booked appointments has increased. In editing. CL: Resources, Writing – review & editing. ML:
contrast, the use of online appointment scheduling in university Resources, Writing – review & editing. MK: Methodology,
hospitals is less relevant due to the referral-based system and the Writing – review & editing. TR: Resources, Writing – review &
lack of direct booking options for patients. However, SMS editing. MR: Conceptualization, Data curation, Formal analysis,
reminders still reduce the no-show rate in these settings. These Investigation, Methodology, Project administration, Resources,
findings underscore the context-dependent benefits of OAS and Supervision, Visualization, Writing – original draft, Writing –
highlight the consistent value of reminders, so that an review & editing.
appointment reminder model is currently being developed for all
appointments at the Department of Ophthalmology at the
University Hospital Freiburg. Further research, as outlined in the Funding
Outlook, is needed to optimize these digital tools, particularly
through comparative studies, cost-effectiveness analyses, and the The author(s) declare that financial support was received for
development of more sophisticated, potentially personalized, the research and/or publication of this article. We acknowledge
reminder strategies to maximize efficiency and patient access support by the Open Access Publication Fund of the University
across diverse healthcare settings. of Freiburg.
While healthcare systems and specific OAS implementations
vary globally, the core principles demonstrated here—patient
demand for digital convenience, the potential for OAS to Acknowledgments
enhance efficiency (particularly in primary/private care), and the
utility of automated reminders—possess broad international No third-party submissions or writing assistance were used.
relevance, informing efforts to optimize patient access and We thank all patients and all employees of the ophthalmologists’
resource allocation worldwide. practice “Augenärzte am Städel” and the Ophthalmology
University Hospital of Freiburg.

Data availability statement

Conflict of interest
The original contributions presented in the study are included
in the article/Supplementary Material, further inquiries can be The authors declare that the research was conducted in the
directed to the corresponding author. absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.

Ethics statement
Generative AI statement
The studies involving humans were approved by Ethics
Committee of the responsible State Medical Association of The author(s) declare that no Generative AI was used in the
Hessen. The studies were conducted in accordance with the local creation of this manuscript.
legislation and institutional requirements. Written informed
consent for participation was not required from the participants
or the participants’ legal guardians/next of kin because according Publisher’s note
to a written communication from the Ethics Committee of the
responsible State Medical Association of Hessen, an ethics vote is All claims expressed in this article are solely those of the
not necessary for the present study in accordance with § 15 Abs. authors and do not necessarily represent those of their affiliated
1 BO (ethical approval number: 2024-3837-AF). Under the organizations, or those of the publisher, the editors and the
updated Health Data Utilization Act (GDNG) § 6, as of reviewers. Any product that may be evaluated in this article, or
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Kammrath Betancor et al. 10.3389/fdgth.2025.1567397

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