It costs a lot of money to run a doctor's office. The average wages of nurses in outpatient operations are around CZK 35 000. As an employer, you pay around CZK 12,000 for social security and health insurance, so the nurse costs you over CZK 46,000 in total. In addition, if she answers the phone all day, she does not have time to perform skilled work and reimbursed procedures in the office.

Not available all the time. Cannot handle multiple calls at once. In addition, she may fall ill, go on holiday or go on maternity leave.

You have to train her. It will take a while for her to master ordering into a complexly structured office hours. Otherwise, there is a risk of infectious patients meeting healthy ones in the waiting room, or ordering an appointment that the patient is not entitled to.

Patients order according to their preferences. The practice is losing control of the surgery hours. If a nurse wants to finish early on a Friday, she won't book afternoon patients. Or she gets talked into rushing the patient's appointment and squeezes it in between an already busy schedule.

Lack of image transfer (documents, photos). She cannot look at the application form via the phone and asks the patient what is in it.

She can be unpleasant to patients. If a nurse is constantly stressed due to overloaded phone lines, she may take her frustration out on patients.

There is a risk of misidentification. If a patient gets their name wrong, they call from a different number, or you have several patients with the surname Novak in your practice, most of whom are taking blood pressure medication.

Lack of expertise. When a patient calls, they may have trouble determining the correct course of action because they have no medical training. He or she also won't help you with collections or other specialized procedures.

Arranging appointments is complicated. If the patient doesn't provide important information, you inquire by email or phone. Or the appointment you suggest doesn't suit the patient, but you book it for them in the meantime and later on you have a difficult time finding another appointment.

It does not clearly identify the patient. It often happens that patients have several e-mail addresses. Or you don't have all the contact details (e.g. phone), so establishing follow-up communication is difficult.

Patients follow up on earlier conversations. You receive a months-old subject line "sore thumb" in the email, but the patient is now dealing with a different health concern. Because the thread cannot be easily terminated, the subjects are nondescript.

You are losing track of your pending emails. The mailbox distinguishes only two categories read/unread.

There is no accountability for handling email. If responsibilities are not established, the nurse may assume that the physician handles the e-mail and vice versa. It may be that the practice does not respond to the patient's request at all.

Clinical prioritisation is missing. Urgent cases are not in the correct order for ordering. Difficult to keep track of which patient to prioritise.

Pre-prepared answers are difficult to set. It takes a few minutes to prepare information about absence due to holiday. It is even more difficult (or even impossible) to customize automatic responses using variables - such as the date and time of the appointment.

He's not reliable. It is easy for the sender to make a typo in the recipient, for the message not to be delivered due to lack of space, or for it to end up in spam.

It is a common channel for cyber attacks. It's easy for hackers to attack email - just open an email attachment that contains malware or click on a malicious link. This puts sensitive health data at risk of falling into the wrong hands.

It does not communicate with the outpatient software. Without integration with the software, data overwriting is unavoidable.

Communication is not structured. Patients communicate irrelevant details to the practice. On the other hand, you have to ask for essential information. Moreover, you cannot translate the patient's text into the medical record without change.

There is a lack of boundaries between personal and professional life. If you communicate with patients through your personal email, private correspondence gets mixed up with patient requests.

Answers over the phone are lengthy and impractical. The miniature keyboard is not adapted for longer messages.

It does not allow teamwork. Only one employee can handle messages, the others cannot access them (the exception is the company messenger).

Checking incoming messages is challenging. You don't know where to look first.

You're in danger of losing all privacy. If you use a personal number (or account), it blurs the distinction between your personal and professional life, and messages from patients will disturb you even on holiday.

You are losing control of your order. If you allow patients to make appointments in pre-determined time slots (e.g. 20 minutes), you will have a fully booked appointment 3 days in advance. In this case, you don't have the opportunity to treat patients with acute problems, or you try to squeeze them in between appointments. Plus, you don't have much opportunity to plan practice revenue based on office hours - if you don't actively invite patients to better-paying procedures, they won't come in for them themselves.

There are delays between patient examinations or queues form in the waiting room. In the first case, you lose procedures to the insurance company, in the second, patients are angry. Online appointment booking then becomes meaningless. This is because one-size-fits-all time blocks are not convenient - different problems require different lengths of time to resolve.

It does not allow triage of patients. In a system that is not tailored to medicine, you do not have the ability to allocate separate blocks for infectious and non-infectious patients.

The system does not communicate with the outpatient software. You have to make entries in the medical records manually.

Communication is not structured. When booking online, the patient communicates the details that he or she deems appropriate, not those needed by the practice. Alternatively, the reason for the visit is not given at all.

Image transmission is missing. Online systems generally do not allow attachments (e.g. application forms).

Lack of approval by surgeries or handing over instructions to patients. Certain types of examinations or requirements require preparation. For example, if a patient arrives late for an ultrasound or if they are due to have a scan, it unnecessarily blocks the appointment.

Many people find voice machines annoying. Patients prefer to talk to a human.

The calls often end up going through to the surgery anyway. A lot of requests the IVR can't handle. Patients therefore have to speak to a nurse or doctor, or choose this option deliberately to get their request dealt with more quickly. Even routine activities - such as making an appointment - waste skilled manpower.

You must call the patient to arrange appointments or to clarify missing information.

Creating an IVR and keeping it up to date is quite complex, it is not a trivial matter.

Listening to the answering machine is very time consuming. You have to listen to all the messages one by one. The patient stammers, digresses to irrelevant details or mispronounces the name of the medication. You have to call him again and ask questions.

There is a risk of misidentification. The patient forgets to introduce himself, is not understood or leaves no contact details.

Quite an expensive solution. A small practice will pay up to CZK 2,000/month. Not to mention the high set-up costs.

Communication is impersonal. Some patients may not recognize that they are talking to a voicebot and may be confused.

Patients don't always follow through with their calls. However, surgeries also pay for unfinished calls.

Call transcripts are not always accurate. The surgery must then call back or listen to a recording of the call.

If the practice wants to use online communication with patients, there is another interface that must be monitored. Alternatively, the call information comes in an email (see disadvantages of email above).

Patients must create access to Emmy. However, registering for the patient portal is easy - all they need is an email and a phone number.

It's not free. The most popular tariff costs 1490 CZK/month, the basic one 990 CZK/month. But Emmy will do the job of a part-time nurse/receptionist - 10-12 times cheaper than her .

Patients do not have direct contact with the nurse/doctor when making requests. However, doctors do not cancel the phone line - they leave it open for urgent matters.