The situation
Every Author Health intake appointment opened with a Medical Assistant (MA) joining the video visit, to walk through demographic information, medications, and 3 required clinical questionnaires for depression (PHQ-9), anxiety (GAD-7), and dementia (MoCA). These assessments feed directly into treatment decisions and quality reporting, providing a critical baseline for patients entering care. These steps historically took up to 30 minutes of MA time before the provider joined. The MoCA alone could take 20+ minutes and proved highly challenging to administer in a virtual setting, so it was commonly skipped.
Author was growing quickly, and we were trying to identify ways to scale our virtual clinic without linearly scaling our MA staff. I hypothesized that at least 25% of our patient population would be willing and able to complete these assessments self-service before their intake appointment. There was precedent for this hypothesis — despite a population that is primarily Medicare Advantage seniors, a vast majority had email addresses, SMS consent, and had signed on for virtual care.
Our clinic also began exploring alternatives to the MoCA that would be more seamless for patients — an opening to rethink cognitive screening alongside everything else.
Designing a self-service path — without losing rigor
I led this initiative end to end — defining the approach, writing the requirements, and building the metrics framework to know if it worked. The plan had five connected parts:
-
Built assessments in the portal
We built self-service assessments in our patient portal (GAD-7, PHQ-9, PCL-5), allowing patients to complete them asynchronously before their appointment, gated behind identity verification and consent-to-treat, with real safeguards built in — including a specific handling path for any answer indicating suicidality on the depression screener.
-
Updated appointment reminders
To ensure patients would know to complete the assessments, we tailored our appointment reminders to include copy and a link to "Check in for your appointment" in the days leading up to the visit — for both intake and follow-up appointments when assessment retakes were due.
-
Launched a faster cognitive screener
We partnered with a new vendor to integrate a 3–5 minute self-screener for cognitive function into the portal — a pre-screener for MCI and dementia, and a dramatically faster alternative to the in-visit MoCA.
-
Kept staff informed
None of this works if providers walk into a visit unsure what's already done. We added visibility into the MA workflow for what assessments were due when the patient joined, and into the clinical workflow, so staff can see patient-generated results at a glance.
-
Extended the cadence
Standard questionnaires had come due every 30 days regardless of clinical need. Stretching that to 90 days — while preserving a provider's ability to trigger one anytime — cut how often patients needed to engage at all.
What changed
Since launch, the shift has held — not a one-time spike, but a consistent pattern month over month. Roughly double the 25% adoption I'd hypothesized going in:
We handed back MA time for nearly half of all intake appointments — and for the cognitive screener, a workflow that couldn't have existed in its old form. The self-administered version doesn't just save staff time; it opens a faster, more sensitive screening option for patients who might otherwise have gone without one in a time-constrained visit.
The mix shifted, too: in-visit MoCA completions fell roughly 83% after launch, from a monthly average near 330 to about 57. That's a shift in tool, not a screening gap — more patients are being screened for cognitive impairment than before, just through a faster, self-administered path for most of them.
Figures reflect internal product metrics current as of mid-2026, generalized for public sharing.