The rates of missed appointments documented in the literature vary greatly. One national study in 1999, which surveyed 468 family practice residency programs in the U.S., obtained a 60 percent response rate. This study, possibly the most comprehensive one available, found that over a third of those practices surveyed had a no-show [defined as "patients who neither kept nor cancelled scheduled appointments"] rate of over 21 percent.

Another study found that both no-shows and cancelled appointments together amounted to 31.1 percent of all appointments made and 32.2 percent of the total time that is scheduled in a given workday. Another study with relatively similar results found that 25 percent of appointments scheduled resulted in missed appointments.

There are a variety of demographic and lifestyle characteristics that are associated with nonattendance. These include the patient's age, the referral source, illness, linguistic capacity, and marital status. Other structural barriers include a lack of transportation, lack of a telephone, being a single mother, long wait times, low socio-economic status, and use of Medicaid.

The loss of the revenue associated with the visit is obvious, but what may not be as apparent are the many hidden costs. With a missed appointment, all the time and effort spent confirming insurance coverage, previewing the patient's chart, readying the exam room, and other tasks, are all lost. Additional resources, moreover, must be spent after patients miss their appointments. In sum, every missed appointment costs your practice big bucks—$100 to more than $500, depending on your specialty and setting.

Prevention is the best medicine. [In addition to the normal reminders], enhance your chances for a successful outcome by texting patients to remind them about their visits two hours in advance of their appointment.

My partner was sued by a patient who developed breast cancer after failing to keep three referrals to a breast specialist for evaluation of an abnormal mammogram. The expert witness (an MD) said that the standard of care would have been for my partner to provide transportation and accompany the patient (a Ph.D. in her forties) to the specialist's office. After three years and over $400,000 in defensive legal fees, the case was dropped with no settlement.

Current products are usually a small part of a much bigger and more complex and expensive platform, and many customers do not really want or need all the other tools that are included. Cost per reminder on current products ranges from 12.5 cents to 50 cents per reminder. Notifly will be significantly less expensive, as low as 2 to 4 cents per reminder.

We also wanted to reduce user error. In a number of current programs, many fields have to filled out, slowing down adoption, as well as making it complicated for the end user. In Notifly, we make it simple: You answer two questions, and the system does the rest.

Adaptive learning in the software, and our knowledge of peak response times assures that the SMS is sent out at the optimum time.