Epic Fast Pass is an automated waitlist feature built into the Epic electronic health record system that fills canceled or newly opened appointment slots by offering them directly to patients through their MyChart portal or via text message. When it works as intended, patients who accept an offered slot move their appointments up by roughly three weeks on average, and health systems recapture time that would otherwise go unused. The tool has been deployed across routine outpatient visits and, more recently, specialized procedures like echocardiograms and endoscopies, with early results showing meaningful reductions in wait times and no-show rates.
How the System Actually Works
The basic idea is straightforward. When you book an appointment for, say, a cardiology visit or a colonoscopy, your care team can add you to a digital waitlist for that appointment type, procedure, or specific provider. You don’t need to do anything extra. From that point on, whenever another patient cancels and a slot opens up, Epic Fast Pass automatically identifies waitlisted patients who could fill that opening and sends them an offer through MyChart or as a text message. You can accept the earlier slot, decline it, or simply ignore it and keep your original appointment.
The tool is designed to run without requiring staff to manually scan schedules for gaps. That matters because the old way of handling cancellations was labor-intensive. Schedulers would comb through upcoming appointment lists, call patients one by one to see if anyone wanted to come in sooner, and often get voicemails. Providers themselves sometimes got pulled into these back-and-forth conversations. Fast Pass replaces much of that manual rework with an automated matching process that runs continuously in the background.
The Numbers on Wait-Time Improvement
A large-scale study covering calendar year 2023 found that the automated waitlist process generated over one million appointment offers across roughly 230,000 waitlisted appointments for more than 164,000 patients. About a third of those waitlisted appointments received their first offer within two days of being placed on the list, which suggests the system catches openings quickly when cancellations are common. Just under half of the waitlisted appointments received at least one patient response, and about one in four resulted in an accepted offer. Patients who did accept moved their visits up by an average of 22.6 days.1PubMed Central. Enhancing the Performance of Patient Appointment Scheduling: Outcomes of an Automated Waitlist Process to Improve Patient Wait Times for Appointments
Three weeks may not sound dramatic in isolation, but for someone waiting two or three months for a specialist visit, shaving off 23 days can be the difference between a condition being caught early or progressing. It also adds up at the system level. Thousands of previously wasted appointment slots get filled, which means providers stay productive and the overall backlog of patients shrinks incrementally over time.
Beyond Routine Visits: Echocardiograms and Endoscopies
Fast Pass was initially rolled out for standard outpatient appointments, but more recently it has been adapted for imaging and procedural services where scheduling complexity is higher. A study describing this expansion to echocardiograms and endoscopies found that the tool worked well in both contexts, though the results differed in interesting ways between the two procedure types.2PubMed Central. Implementing epic fast pass for echocardiogram and endoscopy to improve healthcare access and utilization
For echocardiograms, about 41% of patients who received a Fast Pass offer accepted it, and they moved their appointments up by an average of roughly 13 days. For endoscopies, the acceptance rate was even higher at about 48%, and the average improvement was far more striking: patients got their procedures more than 50 days sooner.3PubMed Central. Implementing epic fast pass for echocardiogram and endoscopy to improve healthcare access and utilization – Section: Results
The difference between 13 days and 50 days likely reflects how long the baseline wait for each procedure tends to be. Endoscopy wait lists are often months long, which means there is more room for improvement when a slot opens up. Echocardiogram scheduling tends to be tighter to begin with, so the gains are smaller in absolute terms. Still, nearly half of endoscopy patients saying yes to an earlier slot is a strong signal that people are motivated to come in sooner when given a frictionless way to do so.
Why It Reduces No-Shows
One of the more practically significant findings about Fast Pass is its effect on appointment no-shows. A retrospective study comparing Fast Pass-accepted appointments to otherwise similar appointments found a 38% relative reduction in the no-show rate among patients who took an earlier slot.4PubMed Central. Patient-Centric Scheduling With the Implementation of Health Information Technology to Improve the Patient Experience and Access to Care: Retrospective Case-Control Analysis
This makes intuitive sense for a few reasons. First, patients who actively accept a new appointment are demonstrating engagement with their care at that moment. They are opening their MyChart, reading the offer, and consciously choosing to come in. That is a very different psychological state from someone who booked an appointment months ago and may have since forgotten about it or lost motivation. Second, the shorter wait between booking and showing up leaves less time for life to intervene. The longer someone waits for an appointment, the more likely they are to move, change insurance, resolve the symptom on their own, or simply forget. Fast Pass compresses that gap.
No-shows are expensive for health systems and harmful for patients in the aggregate. Every empty slot represents care that someone else could have received. In specialties with long wait lists, a single no-show can mean another patient waits weeks longer. Tools that reduce no-show rates even modestly have outsized ripple effects on access.
What Happens on the Patient’s End
If you’ve been placed on an Epic Fast Pass waitlist, the experience is relatively low-friction. You receive a notification through MyChart or a text message telling you that an earlier appointment is available. The notification typically includes the date, time, and location. You can accept or decline right from your phone. If you decline or don’t respond within a set window, the offer goes to the next person on the waitlist, and your original appointment stays unchanged.
The data from the 2023 study show that about 45% of waitlisted patients engaged with at least one offer, meaning they responded in some way rather than letting the message sit unread. Of those who engaged, a solid chunk ended up accepting. But the accept rate of about 25% across all waitlisted appointments means the majority of offers go unclaimed.1PubMed Central. Enhancing the Performance of Patient Appointment Scheduling: Outcomes of an Automated Waitlist Process to Improve Patient Wait Times for Appointments
There are plenty of legitimate reasons someone might decline. The offered time might conflict with work. The location might be different from the one they originally chose. Some patients feel anxious about changing plans once they’ve mentally prepared for a specific date. And for procedures that require preparation, such as bowel prep for a colonoscopy, a suddenly earlier date can actually be harder to accommodate than a later one you’ve had weeks to plan around.
The Digital Access Gap
Fast Pass relies entirely on patients having an active MyChart account or a phone that can receive text messages. That is a real limitation, because patient portal adoption is not evenly distributed across the population. Research on portal enrollment has consistently found that Black, Hispanic, and older patients are less likely to be enrolled in and actively using patient portals compared to white and younger patients.5PubMed Central. Disparities in enrollment and use of an electronic patient portal
A separate study looking at why these gaps persist found that the problem is not just about patients choosing not to sign up. Black and Hispanic individuals were less likely to be offered a portal by their providers in the first place, and among those who were offered one, they were still less likely to access it.6Journal of the American Medical Informatics Association. Disparities in patient portal access and the role of providers in encouraging access and use
What this means for Fast Pass is that the patients who stand to benefit most from earlier appointments, particularly those in underserved communities with longer baseline wait times, may be the least likely to receive or be able to respond to offers. A tool that speeds up access for digitally engaged patients while bypassing everyone else risks widening existing gaps. Health systems implementing Fast Pass should be thinking about complementary outreach strategies for patients without portal access, whether that means phone calls, multilingual text options, or in-person scheduling support.
Reducing Pressure on Emergency Departments
When patients cannot get timely outpatient appointments, some of them end up in emergency departments for issues that could have been handled in a clinic. This is well documented and is one of the drivers behind initiatives to improve scheduling efficiency. Research on scheduling outpatient follow-up appointments at the time of emergency department discharge found that doing so significantly reduced the number of return ED visits per patient.7PubMed. Improving Outpatient Follow-Up Through Innovative Appointment Scheduling at Emergency Department Discharge
Fast Pass fits into this picture as one piece of a larger effort. If a patient leaves the ED with a follow-up cardiology appointment scheduled for eight weeks out, being offered a slot three weeks sooner through Fast Pass could make the difference between appropriate outpatient follow-up and a return trip to the emergency room when symptoms recur. The connection is indirect, and no published study has yet measured Fast Pass’s specific impact on ED utilization. But the logic is sound: shorter waits for outpatient care reduce the likelihood that patients escalate to emergency settings out of frustration or clinical necessity.
The Staff Side of the Equation
From the perspective of schedulers and clinic staff, Fast Pass addresses a problem that has been difficult to even measure. Patients who want an earlier appointment often call back repeatedly, sometimes weekly, to ask if anything has opened up. Each of those calls takes staff time, pulls attention from other tasks, and frequently involves manually scanning provider schedules for gaps. In busy practices, providers themselves get drawn into the process, fielding messages about whether a patient can be squeezed in sooner.1PubMed Central. Enhancing the Performance of Patient Appointment Scheduling: Outcomes of an Automated Waitlist Process to Improve Patient Wait Times for Appointments
Automating this workflow does not eliminate the need for human schedulers, but it redirects their effort toward situations that genuinely require personal judgment: complex multi-appointment coordination, patients with special needs, insurance authorization tangles. The routine “is there anything sooner?” question gets handled by the system instead of by a person on the phone.
Limitations and Open Questions
Fast Pass is not a universal fix for healthcare access problems, and a few limitations are worth understanding. The tool works best in high-volume appointment pools where cancellations are frequent enough to generate a steady stream of openings. A small specialty practice with one provider and a handful of cancellations per month will see less benefit than a large health system running thousands of appointments a week.
The accept rate also has a natural ceiling. At roughly 25% across general outpatient settings and somewhat higher for specific procedures, most offers go unclaimed. Some of that is structural, as the offered times simply don’t work for people. Some of it is behavioral, because not everyone checks MyChart regularly or responds to health system texts. Improving these numbers likely requires better notification design, more flexible appointment windows, and addressing the portal access disparities discussed above.
There is also the question of whether moving appointments earlier always leads to better health outcomes. For routine follow-ups and preventive screenings, faster access is almost always better. But for certain procedures, timing is linked to clinical readiness: a surgical follow-up scheduled at a specific interval post-operation, for instance, or an imaging study timed to a medication cycle. Fast Pass does not replace clinical judgment about when a visit should happen; it simply offers patients the option to fill a gap when the timing works for both sides.
How to Get on the Waitlist
If your health system uses Epic and you want to take advantage of Fast Pass, the process starts with your care team. When you schedule an appointment, ask whether a Fast Pass waitlist is available for that appointment type. Not every department or procedure has it activated, and availability varies by institution. If the waitlist is available, the scheduler or clinical staff can add you at the time of booking.
On your end, the single most important thing is having an active and up-to-date MyChart account with working notification preferences. Make sure your phone number is current and that you have text or push notifications enabled, because offers are time-sensitive. If someone else on the waitlist accepts the slot before you see the message, you won’t get that particular opening. Keeping notifications on and responding quickly improves your chances, especially in high-demand specialties where open slots get snapped up within hours.
It is also worth knowing that you can stay on the waitlist even after declining an offer. Declining one slot does not remove you from consideration for future openings. Your original appointment remains intact throughout the process, so there is no risk involved in being waitlisted. The worst-case scenario is that you keep your existing appointment date, which is exactly what would have happened without the tool.
Where Adoption Stands Now
Epic is the most widely used electronic health record platform in the United States, installed at many of the country’s largest academic medical centers and health systems. Fast Pass, as a built-in feature, is available to any Epic client, but activation and configuration happen at the institutional level. Some organizations have rolled it out broadly across departments, while others have piloted it in limited settings like primary care or specific procedural areas. The extension to echocardiograms and endoscopies described in recent research represents an expansion beyond Fast Pass’s original scope and suggests that health systems are finding enough value to justify the effort of adapting the tool to more complex scheduling environments.2PubMed Central. Implementing epic fast pass for echocardiogram and endoscopy to improve healthcare access and utilization
For patients at institutions that do not use Epic, similar waitlist automation tools exist in other health record platforms, though they vary in sophistication and integration. The underlying concept, automatically offering canceled slots to waitlisted patients through digital communication, is not unique to Epic. But Epic’s version is the most studied and the most widely deployed at scale, which is why most of the published evidence centers on it. If your health system uses a different platform, it is worth asking whether a comparable waitlist feature exists and whether your providers have activated it for your appointment type.