Handling patient bumps in emergencies (e.g. COVID)

No one likes patient bumps – we lose revenues and patient experience is not guaranteed to be good or great. However, we all have to deal with patient bumps from time to time.

Here’s how we handled patient bumps / rescheduling 2150 appointments using a combination of twilio, Google Sheets and zapier. Twilio lets you reach people via SMS in mass and Zapier allows you to automate tasks. Zapier is not HIPAA compliant and Twilio just started taking HIPAA workloads (only recently).

We were not prepared for COVID – no one was. After Mayor DeBlasio’s comments on Sunday, we needed to start rescheduling appointments ASAP.

Of course, we could have had our IT team build a nice little application for us (since they already are experts on Twilio and have built various complicated platforms using Twilio). However, they were already working on other telemedicine, patient relationships management, provider relationship platforms for us.

So, we (the call center folks) decided to take matters into our own hands. 

Let’s agree on a couple of things

  1. A patient bump is when you cancel a patient’s appointment within 30 days due to unplanned absences or personal emergencies. Sometimes it does happen due to other clinical emergencies that take precedence over patient’s appointment.
  2. A patient bump is not when you have national and global emergencies like COVID-19/Coronavirus, or when you have to prepone a patient’s appointment due to their own treatment plan being changed, nor when you have to cancel an appointment because you did not receive their clearances on time.

We knew zapier was not HIPAA compliant so we could not send any PHI to Zapier.

We knew that even though Twilio was taking HIPAA workloads, we could not quite send any PHI data over SMS anyway. So, we would have to send minimally identifying information via SMS while attaining the same goals.

The entire process is this:

  1. We add patient first name and phone number to our google sheet
  2. Zapier picks up this info and sends this data to Twilio. 
  3. Twilio sends SMS to patient
  4. Patient responds back and Twilio gets that SMS response.
  5. Twilio sends out an email with the SMS response to us
  6. We use our email filters to move the email to specific folder
  7. Zapier picks up the email from this folder and adds the body of the email / SMS to another google sheet
  8. Our staff looks at responses and cancels/reschedules appointments.

Preparing Google Sheets 

We exported all appointments from Carecloud for the date range that we wanted to reschedule (2 weeks). We exported this as a CSV file.

Next step was to remove all identifiable information from that CSV file. We were left with just phone numbers and the first name of the patient.

Doing this was pretty simple. We deleted all the columns from the CSV and used the “split data to text” function of Google sheets to get the first name of the patients into 1 column, the phone numbers into another. The only formatting we had to do was using the “Search and replace” function of Google Sheets for the column “Phone”. We made sure that instead of a phone format of (123) 123-1234, we convert this into 11231231234 (the country code at the beginning).

Internally, we kept another sheet that identified the chart number associated with the phone number. This way, when the patient texted us back, we would be ready to update their appointment in Carecloud by searching for that chart number.

Set up sendgrid to send emails upon receiving SMS on Twilio

FYI, you do not need an intermediate step of email.. We needed to have it because we also send out satisfaction surveys using this SMS number as well.

Tie this with Sendgrid to send emails upon receiving SMS on Twilio. Sendgrid does a splendid job of sending transactional and mass emails as well.

For this particular purpose, all you need is to send email when a fax comes in. If you’d like (we had already done it), you can authenticate your domain as well (this part is a little technical)


Make sure you get the API keys from this page on sendgrid

Set up Twilio to send and receive messages

There are very few steps to take and they all are very simple to do.

Open up a twilio account

Buy a phone number – make sure that it can receive phone calls and SMS as well. This is very cheap to buy at

Our advice is to use a local phone number so that patients don’t think it is a spam message.


Make sure when patients call back on this number (trust us, patients will call), forward this to your main phone number.

To do this, all you have to do is to create a simple Twilio function. See this blog to learn how to forward your incoming calls to your office phone number (or numbers)

We have a centralized healthcare call center, so we only had to forward it to one number.


Make sure that when an SMS comes in, you forward this to your email

This is also very simple to do. Just follow this blog and copy/paste the code into a Twilio function.

This is where you are going to need the Sendgrid API Keys.


You can (and should) test this out by sending an SMS to the phone number you purchased from Twilio. If all works well, you will get an email with the SMS you sent.

You should also test this call forwarding by calling the twilio phone number to verify that it actually forwards to your office phone number.

Set up Zapier

Next step was to set up Zapier. This is very simple as well.

Open up a zapier account. 

Add your google sheets account to it.

Add your Twilio account to it.

After doing that, all you have to do is to pull data from Google sheets every time a new row is added there

This is how we did it.

Zapier-customize spreadsheet-inputs

We set up the SMS blast for rescheduling by tying in Twilio to this as well.


Our personalization was limited to the patient’s first name. Our message was simple as well “Considering the current conditions, can we cancel/reschedule your appt at <practice name>? Please reply YES or NO. Stay safe!”

— that’s it !


So, each time a new spreadsheet row is added to our appt rescheduling sheet, Zapier would pick it up instantly, send an SMS to the patient and if the patient responds to the SMS, Twilio will receive it, and send an email to us. 

After that, Zapier will pick that response up and add this data to our spreadsheet so that our medical scheduling .

We set up Zapier to write responses back to a spreadsheet as well. This way, each time an email came in and was labeled as “surveys”, Zapier would pick it up and send it to our spreadsheet.

BTW, you do not need an intermediate step of email.. We needed to have it because we also send out satisfaction surveys using this SMS number.



Then, we started copying/pasting the patient phone number and first name into our main spreadsheet.

That’s it. 

Responses started coming in. Of course, there were patients that did not respond to the SMS. For those patients, our call center folks dialed and spoke to them to reschedule their appointments. That’s pretty much all we had to do to get our patient bumps in order (again, technically speaking, this was not a patient bump situation)

Hopefully this will help you get through these tough times.