ADH Clinic adopts Microsoft Power Platform – a small business survival story

Sameer Bhangar, Principal Program Manager, středa 27. ledna 2021

Banner image for story with photo, screenshot and company information

ADH Clinic is a solo-venture massage, physical, and remedial therapy business based in Taunton, UK. Founded in 2000 by accomplished practitioner Andrea Douthwaite-Hodges, the clinic had successfully been supporting patients in the Somerset area until COVID-19 lockdown restrictions prevented Andrea from seeing her patients anymore.

Faced with the loss of her family’s primary income, the uncertainty of how long COVID restrictions would be in place, and concerns about how ADH Clinic would meet the new regulations, Andrea needed something to save her business.

This post delves into the incredible story of how small business owner Andrea Douthwaite-Hodges partnered with two dear friends who implemented a digital solution that enabled her to safely re-open her clinic during the pandemic. The solution includes Microsoft Bookings, Outlook, Microsoft Forms, Power Apps, Power Automate, and Dataverse (formerly known as Common Data Service). not only helped Andrea’s business to survive but also laid the foundations for it to thrive and grow as never before.

Meet Andrea

Andrea is a highly skilled practitioner who has spent the last two decades building her own private practice alongside gaining valuable experience from her 17 years in the Physiotherapy Department at Nuffield Hospital. Using a multi-faceted approach, Andrea combines her experience as a remedial massage therapist, physical trainer, and reflexologist, along with her experience treating diabetes and obesity management to treat not just symptoms but treat her patients as whole human beings.

Tenacious and driven, Andrea is no stranger to rising through adversity. Following her husband’s stroke in 2016, she embarked on developing her skills further at the ARNI (Action for Rehabilitation from Neurological Injury) Institute to better support him. Consequently, she is now able to offer stroke rehabilitation therapy at her own clinic and help many more people.

Her vast array of qualifications and uniquely personal and holistic approach has earned her complete faith from her loyal patient base, as can be seen by the many touching testimonials featured on her website.

The problem with paper

Before Microsoft Power Platform entered her life, Andrea was successfully running her clinic manually, using a paper diary to manage appointments and take notes for her patients, taking all bookings by phone, and storing paper copies of medical and consent forms in folders, along with paper references for all physiotherapy exercises and all the other material needed on a day-to-day basis.

This way of working presented some challenges:

During patient sessions, Andrea was unable to answer the phone, which meant she was often unable to pick up on booking requests until the end of the day.
If, when she eventually responded, the prospective patient was unavailable, it would trigger a cycle of messaging.
The back and forth of messages and conversations could, in the worst-case scenario, mean a 4-day wait between a patient initially requesting an appointment and receiving an appointment, with a potential opportunity cost in the meantime if Andrea had to hold various appointment slots open for them.
Andrea relied on her memory for recalling her patients’ long-term history. Her notes were entered into a paper diary and required lots of flicking back and forth through pages to find previous treatments and the corresponding notes.

Recognizing the shortcomings of the manual process, and despite her self-professed distrust and aversion to technology, Andrea had tried a CMS system in the past. However, she quickly abandoned it after finding it too difficult to use and not tailored enough towards her needs. For now, the paper (and proven) way of working was, to Andrea, the best solution.

Quote from Andrea Douthwaite-Hodges - "I had a CMS system before, and it’s nothing like Power Apps. It just didn’t work for me, so I still relied on manual notes because I didn’t like the system.”

COVID – The catalyst for change

This landscape was about to see an abrupt upheaval. In March 2020, the United Kingdom went into complete lockdown in reaction to the COVID-19 global pandemic, and suddenly Andrea was faced with the news that she could no longer treat her patients. The first few weeks of lockdown meant no work whatsoever. Due to the nature of her work, Andrea’s concern was two-fold: not just, “How could she get back to work?” but also, “How could she keep her husband, her patients and herself safe while doing so?” She needed to get the clinic back up and running as quickly and as safely as possible. This was a terrifying dichotomy, but one thing was for sure: things could not go back to the way they were.

Quote by Andrea Douthwaite-Hodges - “It was incredibly scary because there was so much uncertainty and I couldn’t work out how I was going to be able to keep my husband safe, earn a living, and gut a clinic at the same time. It was huge, absolutely huge, and – for me personally – incredibly frightening.”

To find a way forward, Andrea turned to her close friends Taiki Yoshida, Microsoft employee and passionate Power Platform Community member, and Chris Ma, a Musical Director in London’s West End, for help.

“You need to upgrade,” Taiki told her, which seemed mind-boggling at first to Andrea, who had just been thinking about how to get the practice back up and running during COVID. But Taiki’s vision was to take this as an opportunity to convert Andrea’s business into the way of working she had always dreamed of.

When asked, “In a perfect world, what would you want to do?” Andrea identified two key things that needed to change:

First, she wanted to ‘gut’ her clinic, completely revamping it with the latest equipment and allowing her to have an environment that could be entirely washed down and sanitized to meet all COVID-19 regulations.
Second, she wanted a fully automated system in place to hold all patient information, resources, and medical forms needed for her work.

The first of these would need to be handled with the mortgage company, who – to Andrea’s astonishment – were more than happy to provide her a mortgage holiday to get her business back up and running again. With these savings, Andrea was able to change out her carpets for washable floors, get full PPE, new uniforms, and wipe-able and washable hospital grade pillows, as well as install plastic coverings for fabric surfaces in the clinic. To prevent Andrea having to wait to purchase her dream high-level clinical bed, a close family friend kindly lent her the funds for eight weeks, enabling her to get up and running straight away. Modelling her practice on how the dentistry industry was tackling the COVID problem, and her own research about the virus, Andrea was able to reassure herself that the newly refurbished clinic was as safe as it could possibly be made, for her patients, for herself and for her husband.

The second wish was something Microsoft Power Platform could make happen.

Into the Dataverse – Microsoft Power Platform solution

The vision for Andrea and her practice was to create one central location to display all the data about her patients. This would save her time, streamline her booking process, allow her to improve perceptions of her business, and grow her patient base. There were two key streams of work to be done:

Customer facing: Revamp the website and include an automated booking system.
Internal operations: Build a single source of truth for all of Andrea’s information needs, automate the flow of information into this central repository, and create a user-friendly interface for accessing the data.

The initial challenge would be converting the self-professed “anti-technology” Andrea to a digital way of working. Taiki started in May by introducing her to an Outlook calendar as an online replacement for her diary. She learned the discipline of entering all her appointments, professional and personal, into a digital calendar. Once her calendar was digital, Microsoft Bookings could be used to automate the process for patients to know when Andrea was available and schedule appointments.

The next challenge was to build a user-friendly data store. It was a simple choice: Dataverse would provide Andrea with everything she needed and more:

Store patients’ sensitive and confidential data in a secure and access-restricted manner.
Create relationships between information so that all data about a single patient could be linked together.
Provide a user-friendly interface in the form of a model-driven Power Apps application.
Receive information automatically through integration with the rest of Microsoft Power Platform.

Through a gentle, iterative approach, Andrea was introduced to different elements of the solution, and together with Taiki and Chris, she collaboratively built up the database to be able to store her data in a format that worked for her. While far from an easy process for Andrea, with the encouragement from friends and a user-friendly Power Apps interface, she was able to get to grips with the system and most importantly learn to trust the system.

Quote by Andrea Douthwaite-Hodges: “If you learn to trust it, and if you learn to just allow yourself to embrace the technology, you will survive as a business. But it isn’t just about survival, it’s actually: you’ll thrive, and you’ll grow; you just have to trust the system.”

Online booking system using Microsoft Bookings

For patients, the ADH Clinic experience starts with Andrea’s new website. From here, prospective patients can select a treatment and their desired date & time, with full visibility of all Andrea’s available slots ready to choose from. They then fill in their contact details and automatically receive an email confirming their booking and blocking out the appointment in their Outlook calendar. The email also contains a link for the patient to manage their booking, which is a well-loved feature, giving patients the autonomy to reschedule or cancel their own bookings at the click of a button.

Screenshot of Microsoft Bookings page to schedule appointments

Patients book appointments on website, powered by Microsoft Bookings

Screenshots of confirmation email and Microsoft Bookings screen to manage appointments

Left: Screen for canceling or rescheduling appointment; Right: Confirmation email after appointment is booked.
Note: No real-life personal data is displayed in any screenshots; all data shown is for illustration purposes only.

A native feature in Microsoft Bookings is its ability to sync to an Outlook Exchange calendar, meaning that any changes in Andrea’s calendar affect the available slots in the site for patients to book, and any bookings on the website automatically go into Andrea’s calendar. Not only does this ensure that there is only ever one patient on site at a time, but it also provides Andrea with one single source of truth where she can view everything going on in her day.

Quote by Andrea Douthwaite-Hodges: “My CEOs and managers that book in, they say to me, ‘It’s amazing, it’s so efficient’. The ease of use and the ability to self-process without the need for a conversation is essential for those with a busy diary.”

Equally essential to getting a clinic up and running during a time of COVID was the ability to have down time in-between patients for Andrea to do a full cleaning of the clinic: washing the floor, getting changed into a completely new uniform, wiping down and washing all surfaces in the clinic – a process that takes up to 40 minutes. Microsoft Bookings contains an out-of-the-box provision for preventing back-to-back bookings, providing configurable down time between each booking. The implementation means that the patient is never aware of the buffer time, but the next patient cannot book into it, allowing Andrea the freedom to conform to the government’s COVID regulations.

Screenshots of Microsoft Bookings screens used to configure options

Microsoft Bookings admin experience for configuring scheduling options

Additional features in Microsoft Bookings allow Andrea to:

Set up automated reminders with a customized link to the medical information form.
Edit the names and descriptions of services and add extra services that patients can book.
Set the minimum lead time for patients to book appointments to ensure she will be available.
See the quantity of bookings at a glance, giving Andrea far more visibility into how well the clinic is doing and whether she needs to send out some gentle reminders to patients to try to hit her personal bookings targets.

Quote by Andrea Douthwaite-Hodges: “For the first time ever, I saw what was happening in real time. What was really interesting was that I could see the estimated revenue and compare it to my goal; it was a visual reminder and rather than having to go through diary, the information was just there for me.”

Automated patient forms – using Microsoft Forms and Power Automate

Replacing the paper medical form was a must to get the clinic back in business. Once patients have booked an appointment, they are sent a link to an online medical form, created using Microsoft Forms. This form gives Andrea all the information she needs prior to an individual coming in for treatment.

The responses from the digital medical form are gathered automatically by a Power Automate cloud flow, which adds the response data into Dataverse. If the response comes from a patient who is already in the system, the medical details are automatically linked to that patient. If there is no match, a new patient is created in the system and the medical details are linked to this new patient. This ensures that no erroneous duplicate patient records are created, the latest medical information is available in the Patient view in the model-driven app, and Andrea immediately has visibility to new patients coming in.

Screenshot of Microsoft Forms form for patient intake and Power Automate cloud flow for adding data into Dataverse

Left: Intake form powered by Microsoft Forms; Right: Power Automate cloud flow – copies form data into Dataverse.
Note: No real-life personal data is displayed in any screenshots; all data shown is for illustration purposes only.

Quote by Andrea: “The beauty of this is that it gives me an immediate set of information, and because everyone’s answering the same questions, it’s now in one format. It’s just made my life so much easier.”

Managing patient information – Power Apps model-driven application

The patient’s medical information is automatically moved into the “pièce de résistance” of the solution: The Power Apps model-driven application.

Utilizing the standard Contact from the Common Data Model, Taiki was able to quickly create the Patients table – the backbone of the data model. From there it was a case of building out the relevant forms and views for the data and using sub-grids to surface related records on the patient form, such as the patient’s medical information. The out-of-the-box relational capabilities of Dataverse enables data to be represented from different perspectives, allowing Andrea to see everything pertaining to one patient, but also to see, for example, all medication records across her entire client base.

Screenshot of Power Apps model-driven app used to manage patient information

Power Apps model-driven application used to view and manage all patient details and activities
Note: No real-life personal data is displayed in any screenshots; all data shown is for illustration purposes only.

Using this app enabled Andrea to see all the information about all her patients, organized in a user-friendly, intuitive layout. The patient record page provides an insight into their full contact information and a timeline populated with:

Emails sent out to and received from that patient.
Details of calls made to that patient.
Notes from their appointments.
Any SOAP (Subject, Object, Action, Plan) items that Andrea wishes to capture throughout their time with her.

Quote by Andrea: “Because of the way the information is available, I can scan through and the system gives me the ability to see patterns more easily and more readily. Before, going through manual notes, you’re going to potentially miss details; not because one’s bad, but literally just because it’s manual.”

Additionally, the selected patient’s responses to the medical form are available, along with:

Payments information, so Andrea can manage payments and immediately spot any missing payments.
Medication reference, so Andrea can be aware of what medications her patients are taking, when their medications change, and cross-reference this information – along with her knowledge of drugs and their common side-effects – with any changes in their symptoms or overall health.
Medical contacts, so Andrea knows who she needs to get in touch with to ensure that any treatments she is administering will not conflict with what the patient is getting provided from their GPs.

Andrea also has, in her model-driven app, her own personal COVID Track & Trace solution, which holds every bit of data about who has been in the house, when, and whether they were a patient or a visitor (for example someone delivering equipment to the clinic). Many of her 80 / 90-year-old patients are not comfortable with the NHS app, so this way Andrea still has that information if it becomes relevant, in a manner that she and her patients are comfortable with.

Quote by Andrea: “The beauty of the system is that it means that with regard to COVID safety, I’ve got a double security layer: I’ve got track & trace from the NHS, but I’ve also got my own failsafe version because I’m more comfortable with that.”

Solution Architecture

The solution is powered by Microsoft Dataverse, which acts as the central, relational data store for all of Andrea’s needs. A summary of the system components is as follows:

Microsoft Bookings and Outlook Calendar: Patients use Microsoft Bookings to schedule appointments, which are directly integrated with Andrea’s Outlook Calendar. This is, in turn, synced to Dataverse with the native Server-side Synchronization features in Power Apps, providing the ability to add appointments and emails into patients’ timelines.
Microsoft Forms is used to create patient intake forms; the responses from these forms are brought into Dataverse via a cloud flow in Power Automate.

A Power Apps model-driven application sits on top of Dataverse, surfacing the information and allowing Andrea to create and update her records.

High level solution architecture diagram

High level solution architecture diagram for the patient management system
Note: No real-life personal data is displayed in any screenshots; all data shown is for illustration purposes only.

Impact and benefits

Thanks to the physical refurbishment of the clinic, and the Microsoft Power Platform solution to support it, ADH Clinic was able to re-open for business by the end of August 2020, following all government COVID guidelines and restrictions. Just three months after she first spoke to Taiki and Chris about the challenges she was facing, Andrea was able to go back to work, safe in the knowledge that she was doing everything she possibly could to ensure the safety of her patients and her family, and that her system was there to help her through the process by:

Removing the need for paper forms
Giving Andrea her own Track & Trace failsafe
Reducing non-essential face-to-face time in the clinic.

Upon re-opening, Andrea also found that the system gave her huge time savings. Since she no longer had to manually manage so many admin tasks, her productivity and speed increased by 80%. She reduced the number of peripheral tasks on her plate, allowing her to focus entirely on her patients, their care, and the safety of the clinic.

Quote by Andrea: “The system has given me everything I wanted. I can upload effortlessly and everything is just seamless now. I’m amazed at how much easier it makes things; it’s like having a built-in secretary.”

Along the way, the system has also:

Given Andrea better visibility of patterns in her patients’ health and treatments.
Removed the pain of the booking process and replaced it with a hassle-free, responsive system that better reflects the professionalism of Andrea’s services.
Given extra flexibility for rescheduling and cancelling bookings, improving the experience for her busy customers.
Provided visibility into booking statistics so Andrea can quickly understand how well her clinic is doing.
Allowed Andrea to provide information to GPs, consultants, and hospitals in the format they expect, taking her to a new level of professionalism and helping to drive additional business.

Quote by Andrea: “It really has changed my life and I don’t say that lightly. I found it weirdly humbling, because I didn’t realize how much I needed this system to change my life until I realized how much better I felt because of it. It’s not often ever that I would consider technology to be life-changing, because I’m so ‘anti-technology’, but it’s been life-changing.”

What is even more remarkable is that the solution has not just helped get Andrea back to where she was, but she’s already seeing the business grow in new directions because of her move into the digital world. Typically, a lot of her work is with the elderly, but having an automated booking system has brought a younger generation through Andrea’s doors. It has been a hugely exciting shift which has put her clinic back where she wanted it: to be there for anyone and everyone whenever they need it.

What’s next for Andrea

As her familiarity with the application grows, Andrea is understanding new ways the Microsoft Power Platform system can help her, and together with Taiki is looking into expanding its capabilities. Some key elements planned are:

Integrating finance information into the solution: since Andrea is self-employed, she needs to manually track and calculate her income, expenses, and tax payments, and is keen for this to be added into the system so everything is together in one place.
Additional reporting: inspired by the at-a-glance booking statistics, Andrea now wants to be able to see charts showing how well each service is doing, track the uptake on new treatments, and monitor her clinic’s growth and expansion.

Andrea is also gently easing herself into promoting her success with adopting technology, a topic she always found uncomfortable. She has let technology and the digital sphere more into her life, culminating in her wish to share her story with you today.

Through a huge amount of hard work, determination and tenacity, Andrea, Taiki and Chris, armed with Microsoft Power Platform, have truly turned the fear and uncertainty at the start of lockdown into a chance for ADH Clinic to grow and flourish. It is a solution that has not just helped Andrea keep her business open during a time of COVID, but one that has benefitted her patients, her business, and her own life, and one that she hopes can serve as an inspiration to others in her position.

In Andrea’s own words:

“It has changed my life. That is my truth. That is my reality, and that is the legacy that Taiki has given to me, which in turn has potentially saved my little business.
I’m very private, but I also know that it’s really important to share this for so many reasons, because people have invested in me by making this possible. And, actually, if what I have done can help other people, give them the courage to have their life-changing moment, then we have to do that. We have to do that. It’s not just ‘I’m sorted now’, but a question of ‘Could this save another little business?’, and that is the ethos of what I have come to understand the Power Platform is all about.”

Appendix

Demo – Power Apps model-driven app experience

Animated GIF demo of Power Apps model-driven app