Why Diarybook
The case for automated appointment management in public health settings — the problem, the evidence, and what Diarybook does about it.
Download as PDFThe problem
Ireland's health system loses more than €67 million every year to missed appointments.
More than 525,000 outpatient appointments go unfilled annually — roughly 10,000 every week. Each one represents €129 of wasted clinical time and resource, a figure the HSE itself has formally recognised.
Every missed slot is also a slot that someone on the waiting list could have filled. With over 700,000 people currently waiting for a first outpatient appointment, the connection between missed appointments and waiting list pressure is direct and measurable.
The Department of Health's own research confirms that behaviourally informed SMS reminders alone can reduce DNA rates by 13% — saving an estimated €11.6 million annually if adopted nationally. Diarybook goes significantly further than a simple reminder service.
The platform
What is Diarybook
Diarybook is an appointment management platform built specifically for public health settings. It has been in live use across the HSE, developed in close collaboration with the clinical and administrative teams who use it every day.
It operates in two distinct modes, which is what makes it genuinely flexible across different parts of a health service:
For services that have no existing appointment or scheduling software, Diarybook provides a full end-to-end solution — from appointment booking and calendar management through to automated patient communication and reporting.
For services that already have a patient management or hospital information system, Diarybook integrates alongside it — adding multi-channel reminders and appointment management without replacing existing infrastructure.
This dual-mode approach means Diarybook can be deployed across an entire health service — even where technology maturity varies significantly between departments.
Capabilities
What Diarybook does
- Appointment reminders sent automatically via SMS, email, and voice call
- Automated letter generation for services requiring written communication
- Configurable reminder schedules — days or weeks in advance as required
- Opt-out management built in, fully compliant with data protection requirements
- Complex scheduling across multiple practitioners, locations, and appointment types
- Blocked times, time conflict detection, and work hours configuration
- Attendance status tracking and DNA recording
- Client file management and secure document sharing
- ExcelSend module allows waiting list coordinators to send appointment communications directly from standard Excel spreadsheets — no technical expertise required
- Bridges the gap for services managing waiting lists outside of dedicated software
- Integrates with hospital management systems already in use across the HSE
- Functions as a communication layer without displacing existing workflows
- No staff retraining required on core systems
The evidence
The case is well established in published research
Diarybook's approach is directly aligned with the interventions the evidence supports.
| Finding | Source |
|---|---|
| DNA rates in Irish hospitals range from 7% to 20% depending on specialty and location | Irish Times / FOI data |
| Behaviourally informed SMS reminders reduced DNA rates by 13% in a randomised controlled trial at Naas General Hospital | Dept. of Health — Better Letter Initiative (2024) |
| Applying that finding nationally could save €11.6 million annually | Dept. of Health (2024) |
| The HSE Outpatient DNA Strategy (2023) mandates SMS reminders as standard practice | HSE DNA Strategy |
| Each missed NHS outpatient appointment costs £165 in wasted clinical time and administration | NHS England (2023–24) |
| Advanced reminder optimisation reduced DNA rates from 10% to 4% at one NHS trust | Business News Today (2025) |
| Behavioural messaging interventions can reduce DNAs by up to 30% | NHS research synthesis |
Deployment
What implementation looks like
One of the most common questions from decision makers is what deploying Diarybook actually requires — in time, resource, and disruption. The answer depends on which mode is being deployed, but in both cases the process is designed to be straightforward.
For services adopting Diarybook as a standalone system, onboarding involves configuration of the schedule, appointment types, staff accounts, and communication templates. This is completed collaboratively and does not require IT involvement. Most services are live within days.
For services integrating Diarybook alongside an existing system, the main task sits with the client's IT team: building a query against the existing patient management system and scheduling a daily automated upload to Diarybook's secure endpoint. The format is well-defined and the scope is modest — most IT teams complete it within days of prioritising it. Once the feed is running, Diarybook handles everything downstream.
In both cases, support is included from day one. There is no implementation consultant to hire and no onboarding fee.
The case for acting now
Why now
The HSE's 2024 Waiting List Action Plan committed €360 million to reducing waiting lists — and despite that investment, waiting lists continued to grow. The reason is straightforward: adding capacity does not solve the problem of unused capacity. Every missed appointment is a slot that could have been reallocated to someone waiting.
The HSE's own DNA Strategy, published in 2023, sets out the obligation to send SMS reminders as standard practice. Diarybook provides the infrastructure to deliver that obligation — and to go significantly beyond it.
Sources
- 1Department of Health Ireland — Better Letter Initiative (2024)
- 2HSE Outpatient DNA Strategy (2023)
- 3Irish Times / Irish Country Living — FOI-sourced HSE DNA figures
- 4Donegal News — HSE €129 per missed appointment figure (January 2026)
- 5IHCA — Hospital waiting list figures (2024)
- 6NHS England — Missed appointments data (2023–24)
- 7Esendex UK — NHS DNA cost analysis (2024)
- 8Deep Medical / Business News Today — NHS intervention research