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The Waiting Room – A Patient’s First Impression

Posted on September 23, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is sponsored by Samsung Business. All thoughts and opinions are my own.

We’ve all heard about the importance of first impressions. They last a long time and happen very quickly. The same is true for a medical practice. Patients’ first impression of a medical practice is the waiting room and that impression can last a very long time. What have you done to improve your patients’ experience in the waiting room?

Instead of doing a bunch of small things in your waiting room, I suggest you focus on creating one specific WOW! factor that patients will remember. In many cases people are turning to digital signage to provide this wow factor. Combine amazing content with some amazing digital signage like a curved TV, 3D TV, or massive screen and you can quickly implement the WOW! factor in your waiting room.

These type of memorable experiences for patients in your waiting room are the fuel that feeds social media and physician rating services today. If you want patients to share their experience at your office on social media or rate you highly on the various physician rating websites, start by WOWing them in your waiting room. Almost all of your patients now arrive with a phone in their pocket which they can use while they wait to provide your practice a quality rating. Leverage that as an asset.

I’ve heard some people argue that digital signage isn’t valuable anymore in the exam room because patients all show up with their own smartphones and tablets. They argue that patients have their heads buried in their phones and so they never see the digital signage you put in the exam room. This couldn’t be further from the truth.

The reality is that most of us with smartphones have become quite habituated to what people call the second screen experience. More and more people are watching TV while playing on their smartphone. It’s normal for us to be processing what’s on a TV while keeping an eye on our smartphone at the same time. The same thing happens in the waiting room when you provide a compelling digital experience. We consume both the TV and our smartphone.

Leveraging a high-quality digital experience in your waiting room provides a better patient experience overall. What’s the worst part of a waiting room? You have to wait. What’s the solution? We all have experienced a long flight or car ride that felt like it was much shorter thanks to some sort of digital media experience. This same experience can be had by patients if you invest in the right digital signage and content. Shorter wait times lead to better physician ratings in ambulatory practices and better HCAHPS scores in hospitals.

How have you approached your waiting room? Is there something unique or interesting you’ve done that’s made the patient experience better? What kind of first impression are you making on your patients?

For more content like this, follow Samsung on Insights, Twitter, LinkedIn , YouTube and SlideShare.

Gastroparesis – A Patient Story

Posted on September 2, 2016 I Written By

The following is a guest blog post by Melissa Adams VanHouten. You can read more about her on her Gastroparesis: Fighting for Change website and her blog.
Melissa Adams VanHouten - Gastroparesis
Since being diagnosed with gastroparesis, my life has changed in unimaginable ways – and the medical community, which did not initially recognize my complex needs, left me ill-prepared for these changes.  In February 2014, I was hospitalized with severe pain and vomiting, put through a battery of tests, diagnosed, and sent home with only a brief explanation of my illness. No one prepared me for the seriousness of this condition.  Perhaps they thought I understood, but I did not.

My ordeal began in the ER with blood tests and scans.  When these tests showed nothing of concern, the doctors forced a tube down my nose and pumped my stomach in preparation for an upper endoscopy.  To this day, I have never experienced anything quite so unpleasant and terrifying.  The doctors were kind and warned me that, though necessary, the procedure would be painful.  They did their best to talk me through it, but it was not an experience I ever wish to relive.  In addition to the endoscopy, I was sent for a Gastric Emptying Study (GES) the following day.  This was not a particularly harsh test except for the fact that I was required to keep the food down despite my frequent vomiting episodes.  My situation was not improved by the radiology technician warning me repeatedly and sternly that if I vomited, we would have to repeat the test.  My week was rounded out with more scans, additional blood tests, and a few IV changes.

The good news is that, though the tests were difficult to endure, the nurses and doctors were (for the most part) kind and understanding.  They controlled my pain well, answered my questions when they could, and took reasonable steps to ensure my comfort; however, my stay was not without issues.  There were numerous occasions where I had to ask what medication I was being given and why, and there were a couple of medications that I concluded were unnecessary – such as the “standard treatment” for heartburn, which they assured me everyone who complained of stomach pain received, when I was not experiencing heartburn.  I was also woken up by the blinding overbed light several times during the night, every night, for blood pressure checks and such when I really could have used the rest.  I was discouraged from showering and walking the halls as well, as this seemed to be an inconvenience for the nurses. The biggest issue by far, though, was the coordination of care.  I lost count of how many different medical providers I spoke to, could not understand their various roles in my care, and was required to repeat my “story” every time someone new arrived.  I would have loved to have felt as if everyone working with me was “on the same page.”

Fortunately, at the end of my week’s stay, I did receive a diagnosis.  I am thankful I was diagnosed so quickly, since many in my community spend weeks, months, or even years seeking answers.  What is not quite so fortunate is that, upon my release, I was sent home with very little information regarding my condition and was told simply to follow up with a gastroenterologist in about 6 weeks.  I had no detailed diet plan, no medications to try, and no idea what to expect.

I recall the doctors giving me an overview of gastroparesis.  They told me it was “paralysis of the stomach” and impressed upon me that there was no cure.  I remember them saying I would need to make some dietary changes, and if those didn’t work, there were a few medications to try – but they came with risks and negative side effects.  I recall them telling me that in some severe cases, people would opt for surgery to implant a gastric electrical stimulator or resort to feeding tubes.  Mostly, though, I remember them saying that some would recover almost completely over time and would not experience long-term effects.  Of course, this last statement is what I believed would be the case for me.  After all, I was in good overall health.  Not a big deal.  I would follow a liquids-only diet, work my way up to soft foods and solids, just as they indicated I should, and I would be fine.

But it did not happen that way.  I went home believing I would continue to improve; instead, my condition deteriorated.  Within a couple of days, I started vomiting again and could barely keep down liquids.  The attacks of pain worsened, and I became so weak that I honestly could not lift my head up.  I told my family goodbye.  I truly believed I would die.  I could not get in quickly to see my new gastroenterologist, and I had no idea what to do.  I finally mustered up the courage to call my doctor and told him that despite the risks, I thought I should try one of the medications the hospital doctors had mentioned.  He agreed, but because of FDA restrictions and requirements associated with my particular medication, it was two horrendous weeks before I could begin taking it.  These were without a doubt the longest two weeks of my life.

Since starting the medication, I have stopped vomiting (for the most part) and can now function well enough to make it through the day, but I still cannot eat without pain.  It is clear to me now that I will likely never again be able to eat “normal” foods in “normal” amounts, and it is crystal clear to me that this is a life-altering disease from which there is perhaps no coming back.  I have experienced levels of fatigue I previously thought impossible, endured unfathomable pain, and come to realize the horrors of hunger and malnutrition.  I had no idea I would face this.  The doctors did not impress on me that this was a serious, chronic illness, and they left me in the dark as to how to cope with my illness should it not resolve itself, as I had believed it would upon leaving the hospital.

I am thankful I now have a physician who is willing to listen to my concerns and partner with me in evaluating treatment options.  Though there are few treatments available for gastroparesis, my doctor seems to genuinely care and refuses to give up on me.  That means the world to a person in my circumstances.  My experience differs from many in the gastroparesis community.  Unlike me, they remain lost and confused, as I was immediately after diagnosis.  They never find that competent, compassionate doctor.  These are the people for whom I advocate.  I hope that eventually we are able to establish a healthcare system that meets the needs of all.  We need better care, better treatments, and a medical community that comprehends our needs.

This post is part of our effort to remind us of the patient perspective by sharing patients’ stories. Thanks Melissa for sharing your story with us. If you have a patient story you’d like to share, please reach out to us on our Contact Us page.

What Do Consumers Demand from Modern Healthcare?

Posted on August 26, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Consumer Demand for Modern Healthcare IT

This represents some really fascinating data and illustrates a major trend around consumer demand in healthcare. More and more patients are comfortable with some form of electronic healthcare. Over time I’m sure that this acceptance is going to grow into pure demand for these type of modern healthcare options. Are you prepared for this change?

Right now, most doctors don’t need to offer the services described above. Patients don’t generally choose their doctor using the above criteria, but over time I think that will likely change. As patients get the first glimpse of how much easier a telemedicine visit was as compared to an office visit, they’re going to want more. It’s the natural process of how these things evolve.

My fear is that many small practices are asleep at the wheel in this regard. This will likely lead to problems since their big health system competitors are going to roll this out in a broad way that could make it hard for small practices to compete if they don’t get on it early. Plus, large health system competitors will be able to do things like offer 24 hour services that a small practice just can’t reasonably offer.

At the end of the day, every small practice needs to ask themselves, what am I doing to create an amazing patient experience for those in my care. Small practices that do this will be successful and retain patients. Those that continue practicing business as usual will likely run into difficulties as consumer driven healthcare starts to take over.

Patient Engagement Distracts the Health Care Field From Reform (Part 2 of 2)

Posted on January 12, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The previous segment of this article looked at the movement for patient engagement, or the patient experience. Now I’ll highlight a true reform in the health care system.

Patients Left Out in the Cold
What activist patients and doctors have been demanding for years is not engagement or a better experience, but a central role for the patient in choosing treatment and carrying it out when they leave the doctor’s office. Patient empowerment is the key to all the things doctors profess to care about, such as preventing readmissions. It’s even more critical with chronic diseases that have a lifestyle component, such as congestive heart failure and diabetes.

Some patients come to the clinical setting endowed with more education than others, or a personality suited to pushing back and demanding rights. But some fight for years for such basics as access to their records. I was dejected to read just a few weeks ago of an attempt to improve care in Rhode Island, endorsed no less by the American College of Physicians, that boasts about giving access to everybody except the patient to health records.

The American College of Physicians is concerned about the hypothetical patient who “doesn’t know the name of the peach-colored pill that the orthopedist prescribed.” That particular patient is clearly not asking for empowerment. But millions do keep track of their medications and deserve equal knowledge about the rest of the information about their medical condition. If the peach-colored pill had been recorded in a patient health record, accessible to the patient (or a responsible care-giver) wherever she goes, all the complex Health Information Exchange infrastructure praised in the article could go by the wayside. Another article describes an emerging PHR solution.

Another recent example of the disdain for patients comes in a complaint by AHIMA about the difficulties of matching records for a single patient. Duplicate records are undeniably a serious problem (as is information mistakenly entered in a different person’s record). But instead of recognizing the obvious solution of a PHR, all they can come up with is a universal identifier (which is a privacy risk as well as a target for security attacks) and more determined efforts to match patients the old-fashioned way.

Empowered patients have control over their own information. Doctors guide them to make reasonable choices that affect their health, which includes sharing those records. Empowered patients set their own goals and timetables. A grant of power and information to patients will inevitably empower and inform the other health professionals with whom those patients interact, leading to a learning health system and a true team approach to care.

What’s the difference?
As I eventually admitted, the movement for patient engagement offers many good ideas that can contribute not only to a better experience in the health care center but to patient empowerment and better outcomes. What I complain about is the motive behind patient engagement.

Let’s take patient portals. To proponents of patient engagement, it serves a few purposes related to public relations. The portal hopefully:

  • Indulges people’s preference for fast information, endearing them to the practice

  • Keeps them more “engaged,” meaning that they’ll come back and spend more money at the health care center.

  • Delivers information in more appealing ways (such as through video, when practices use it).

  • Takes routine tasks off the shoulders of staff, freeing them to do other things that improve the patient experience.

This poverty of vision is why most portals lack useful information that patients can use to actually improve their care. Discharge instructions are usually a crumpled page. Doctor notes are hidden away, available to malicious attackers more easily than to patients. Medical codes and raw numbers appear on the portal without further elucidation.

Modern health facilities use web sites along with text messaging, old-fashioned phone calls, and other tools as part of a strategy to keep patients on their treatment plans. They may have full discharge instructions, along with instructional videos for such important tasks as changing bandages, on a patient’s personal site. The patient is encouraged to report her progress along with any setbacks, and gets quick feedback when there is a change. Many face-to-face visits can be averted, and patients who can update their caretakers without leaving home are less likely to exhaust themselves at vulnerable times. The patient’s family members can easily keep up with changes and find out what they need to do, as can other professionals working on the case.

For every element of empowerment, there is a tawdry alternative that can be offered as “engagement.” That’s the risk in the patient experience movement. Unless the health care institutions start out with the philosophy of empowerment, it’s just another distraction from the work we need to do.

Patient Engagement Distracts the Health Care Field From Reform (Part 1 of 2)

Posted on January 11, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

One can derive a certain sense of entertainment, along with a discomfort comparable to the unending alarms one hears in the background of a hospital ward, when one sees an industry fumble over a critical task and seek desperately for a solution that takes the heat off of them while freeing them from the thoroughgoing cultural and organizational change that the crisis clearly calls for. If you haven’t figured out the issue I’m talking about yet, it’s the hot topic in health care circles these days: patient engagement.

Patient engagement is starkly counterposed to patient empowerment, which is the demand issued by the activists most engaged in health care these days. This article will look at the overlap and differences.

The Elusive Hunt for the Happy Patient
Doctors and administrators must be annoyed at having take time away from busy schedules to learn new bedside manners, but articles pour out on web sites almost daily telling them they need to do so. Typical titles are Social Media 101 For Healthcare CXOs and 5 Elements of a Successful Patient Engagement Strategy. A whole new job description has been even created: the patient experience officer, adding another expensive office to the hospital bureaucracy (with a concomitant rise in hospital costs, I’m sure).

I’ll double back later and admit that many of recommended strategies could help improve care. But an initial indulgence in cynicism is still justified.

Atul Gawande contributed to the fervor for treating patients as customers through his notorious ode to the Cheesecake Factory. The strengths and weaknesses of that comparison have been intelligently analyzed by numerous articles, such as ones in Forbes and KevinMD.

Another commentary shrewdly notes that clinicians themselves suppress patient engagement through problems ranging from lack of record sharing to opaque pricing.

One can sympathize with clinical administrators caught up in the rating frenzy that has overtaken everything we buy and every institution with which we interact. People seem to listen to other people’s rants over long waits or snippy receptionists when choosing which doctor to call (that is, people, lucky enough to have a choice of doctors–a topic beyond the scope of this article). The Department of Health and Human Services has legitimized the concern for patient ratings with its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, introduced in 2006. CMS uses a hospital’s score while determining its Medicare pay rate for inpatient care. (There’s help yet again for beleaguered administrators: Five Tips to Improve Your HCAHPS Scores).

OK, patient experience is important. I certainly couldn’t argue against empathy or compassion. One study found that communicating well with patients contributes more than other “quality measures” to reducing hospital readmissions. The critical issue of patient access to records will be addressed in my next section. More minor improvements to the patient experience can have ripple effects–for instance, moving them through the waiting room and examination faster reduces their risk of picking up infections. Even the snippy receptionist contributes to stress that’s bad for health, or discourages a patient from making an important follow-up visit.

But patient experience does not equal good care. As highlighted in an article in the Atlantic Magazine, patients are easily misled by superficial conveniences. Real improvement in care, the article says, comes from more nurses and a better working environment.

If people are dropping right and left from bugs picked up in restaurants (as they did in a number of Chipotle outlets), we wouldn’t be asking customers to rate the foam on their coffees or whether the waiters smiled at them. We’d be instituting a strong restaurant inspection regimen.

That’s the position of our hospitals and clinics. We have much worse things to worry about than the lengths of time spent in the waiting room. But if we want a focus on patients, there’s another way to do it that I’ll discuss in the next segment of the article.

What Does It Take to Create the Ideal Patient Experience? – #MyIdealPtExp

Posted on December 14, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This new world of social media has created so many virtual friends for me. Over time I’ve had a chance to meet so many of them in person. While sometimes it’s a disappointment meeting someone in person, I’ve also had the opposite experience. This happened at RSNA when I got a chance to meet Andy DeLaO (@CancerGeek) in person. I’d always been impressed by his insightful tweets over the years. So, I was blown away when he was even more impressive and insightful in person. I love it when that happens.

One of the most impressive things he showed me was his new effort around what he calls My Ideal Patient Experience. He even had these really cool coins to hand out which was a great way for me to remember his concept:
My Ideal Patient Experience
Andy the team behind My Ideal Patient Experience has gone through the research and defined the patient experience using these 4 pillars:

  • Time
  • Trust
  • Transparency
  • Transitions

However, it’s worth considering the connective tissue between all 4 pillars:

Time Leads To Trust, Trust Leads To Transparency , Transparency Leads To Transitions; The 4t’s Lead To Relationships And Success!

Andy and his team have been at this for a while even though they’re just now getting their official patient experience website launched. I love that they’re even keeping track of their stats:

  • 50,850 Patients Impacted
  • 878 Physicians Engaged
  • 46 Clients Worked With
  • 30 Completed Projects

If you’re looking to improve the way you engage with patients or your patient experience, take a second to look at the consulting, market research, healthcare engagement, and education resources they offer. After my experience finally meeting Andy in person, I’m excited to see the impact for good “My Ideal Patient Experience” will have on healthcare. Plus, I look forward to digging into the concepts even more in the future.

Patient Experience Compared to Airline Experience

Posted on May 6, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was digging through my archive of draft posts and I came upon this tweet that I’d saved for future posting from last year. The tweet is still as applicable today as it was last year. Stephanie Zaremba raises an interesting point of comparison between the patient experience and the airlines experience. Can we learn something from this comparison?

Stephanie is totally right that the airline experience is going down quickly. I hate flying more and more every time I fly. That’s partially because I’m tired of being away from the family, but partially because they keep changing things and very rarely is the change for the better. However, do we really have a choice? If we need to travel, we purchase the plane ticket and grin and bear.

Does this sound a lot like healthcare? Sadly I think it does. Especially the last part. We all need healthcare and so we mostly just grin and bear. We’re seeing a slight change in that mindset with new high deductible plans. However, the medical industry is so complex that most patients just give up on trying to figure it out.

As I’ve thought about this comparison, I’ve wondered what would really change the patient experience. What could really cause things to change? Sadly, I think there’s a desire by many (doctors leading this charge) for a different system where it is a beautiful patient experience, but I don’t see a pathway to that new reality from our current reality.

Reminds me of one of my favorite thought exercises. What if you created an EHR that was focused on the patient and patient care and not on billing and government regulations? That EHR would look totally different than what we have today. Maybe it would look like a Care Management System.