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Addressing Common Patient Frustrations: Wait Times

Posted on April 11, 2018 I Written By

The following is a guest blog post by Jim Higgins, Founder & CEO at Solutionreach. You can follow him on twitter: @higgs77

Experts agree that it is critically important that practices keep their finger on the pulse of patient satisfaction—and one of the best ways to do this is through patient surveys. However, the question remains: what should a practice do if a survey reveals there is a problem?

It is of utmost importance that any issue found in a survey be studied and addressed. Interestingly, the vast majority of patient irritants do not relate to the quality of care at all. In fact, a study in the Journal of Medical Practice Management found that 96 percent of all patient complaints are related to customer service rather than poor care. Some of the biggest complaints include:

  • Excessive waiting times
  • Inadequate communication
  • Disorganized operations

Over the next few months, we will be digging in to each of these topics in depth. Today we will start with the top frustration of patients: excessive wait times. These long wait times, often associated with poor time management, are also some of the major criticisms reported by respondents of the Patient Provider Relationship study. Check out some of these numbers:

  • Sixty-eight percent of patients say that the wait times in their medical office are not reasonable.
  • Sixty-six percent say that they have to wait too long to schedule an appointment.
  • Sixty-eight percent say they feel like messages are not returned in a timely manner.

The problem is only getting worse. Average practice wait times have risen by 30 percent since 2014. Unfortunately, the common patient response to long wait times is simply to change practices. Around one in three patients say they are likely to find a new medical practice in the next couple of years. So how do you reduce long wait times?

  1. Understand how long is too long. Studies have found that about 20 minutes is the maximum amount of time a patient is willing to wait before becoming frustrated. Unfortunately, it is estimated that 53 percent of physicians say patients at their practice typically wait for more than 20 minutes. If you are not sure where you stand in terms of wait time, carefully track your wait times, both in the waiting room and the exam room. There are a variety of programs and apps that can do this for you. Or if you’d prefer to go old-school, you could acquire a supply of timers. When a patient checks in or is taken to the exam room, simply press the START button. Keep an eye on the timers and recognize when a patient has waited longer than is optimal.
  2. Provide clear communication. One of the easiest fixes for long wait times is often overlooked—communication. Eighty-six percent of patients say that if they were told in advance about a long wait time that they would feel less frustrated. So make sure to let patients know if the doctor is running behind schedule. You can also consider shooting off a quick text message to incoming patients if your office is running very late. If you are tracking wait times, make sure to acknowledge the inconvenience and apologize when the wait goes longer than 20 minutes. This would minimize frustration for nearly 70 percent of patients.
  3. Improve front desk workflow. Melanie Michael, lead author of a study that looked at interventions for lowering patient wait times found that one of the critical factors in reducing wait times was the front desk management. She noted, “[At one practice], we found that these people were trying to answer phones, field questions from patients in the waiting room, check patients in, secure insurance info, and many other tasks.” Automation of these tasks enables practices to get patients seen by the physician faster and more efficiently. Appointment reminders, scheduling, and check-in are all processes that can (and should) be automated.

Wait times are directly correlated to the satisfaction of patients. If your patient survey finds that people are feeling annoyed about the wait at your office, make changes now. If you wait too long, you may find you have no patients left.

Solutionreach is a proud sponsor of Healthcare Scene. As the leading provider of patient relationship management solutions, Solutionreach is dedicated to helping practices improve the patient experience while saving time for providers and staff.

Easy Tips to Understand and Leverage Patient Survey Results

Posted on March 14, 2018 I Written By

The following is a guest blog post by Jim Higgins, Founder & CEO at Solutionreach. You can follow him on twitter: @higgs77

Multiple studies have shown that surveys are critical to the economic health of medical practices. Experts say that using surveys to improve the patient experience can be a strategic differentiator for practices.

To read more about the increasing role of surveys in reimbursement, profitability, and quality care, check out this post from last month.

Once you’ve started sending out regular patient surveys and getting consistent responses, it’s time to take action. In order to get the most out of a survey, it is critical to analyze the responses and implement changes based on the results. Here are a few tips to get started.

Figure out how many survey responses are needed.

Any time a survey is sent, there must be enough responses received to have a “statistically significant” result. Obviously, if only one or two patients respond to a survey, those answers will not be a true picture of how patients view a practice. What is considered “statistically significant?” This will vary by practice size.

Start by finding out how many active patients visit your practice—for now, don’t count any inactive files. Of course, it would be amazing if every single patient responded to the survey, but that is pretty near impossible. Instead, each practice must decide what margin of error is acceptable to them personally. The greater margin of error found to be acceptable, the fewer responses needed to be statistically significant. For example, if a 10 percent margin of error is okay with you, only 100 out of 3,000 patients need to respond. If, however, a three percent margin of error makes you more comfortable, you would need 810 responses out of 3,000.

Use the following table as a basic rule of thumb when deciding how many responses are needed:

Leverage technology to calculate the hard numbers.

In order to easily understand survey results, responses need to be converted into percentages or averages (depending on question type) and formatted in a way that makes it easy to compare responses. For example, it doesn’t mean much that 281 respondents said that they had a poor experience. If, however, that number is converted into 40 percent that had a poor experience, it is much easier to recognize a problem. Survey answers should be imported into a system that analyzes the results and converts these into simple statistics. Fortunately, it is common for the platform used to originally send the survey to do this automatically. Many will also include trends over time, highlighting if problems are worse or better during certain times of the year. If the survey-sending platform does not include an analysis tool, there are a huge number of programs (including free tools) that can accomplish this task. Even programs like excel work perfectly fine for this.

Take action.

Great—you’re starting to get a feel for what patients think. But now what? Far too many practices collect incredibly valuable information only to sit on their hands and ignore it. But for a practice to really thrive, it is crucial to set goals and objectives based on survey results. After all, patients are communicating what they want. It’s up to you to see how you can accommodate their needs.

My favorite goal creation method can be remembered by the word SMART.

  • Specific– Select a specific goal, being as clear as possible.
  • Measurable– Decide how you will measure the success or failure of your goal.
  • Achievable – Do you have the time, money and resources to complete the goal?
  • Relevan– Not every goal will improve your business. Pick one that will make a real difference.
  • Timely  Set a realistic deadline for goal completion.

Let’s consider a real-life example. A common survey question for healthcare practices is, “How long did you wait to be seen?” If the score comes up as higher than ideal (typically more than 20 minutes), improvements are needed.

This is where SMART goal setting comes into play.

  • Specific—Set a specific goal. For instance, “Our goal is to lower wait times to 15 minutes.”
  • Measurable—Decide how to measure the result. Will you be timing the waits yourself? Will you send out a follow-up survey?
  • Achievable—Set goals that can realistically be accomplished. If your average wait time is over an hour, for example, trying to adjust that to just 15 minutes is probably not currently achievable. Try to set smaller improvements and over time you can reach your ultimate goal.
  • Relevant—Look at the goal you’ve created. Will lowering wait times improve your business? Don’t set goals that won’t really have an impact on your long-term success. In this case, reducing wait times will have a positive impact on your business so it is a relevant goal.
  • Timely— Set a realistic time frame. It probably won’t happen in a week, but you may not want it to take a year. Three months may be the right timeframe to make improvements. Check back at that point to see if you achieved your goal.

As practices consistently strive to make changes based on survey results, the patient experience will improve dramatically. Because setting specific improvement goals is so important to practice success, over the next few months I’ll be addressing some of the most common patient frustrations uncovered on surveys. I will include SMART goals to improve these frustrations and boost patient satisfaction.

Solutionreach is a proud sponsor of Healthcare Scene. As the leading provider of patient relationship management solutions, Solutionreach is dedicated to helping practices improve the patient experience while saving time for providers and staff.

Positive Patient Experience with an EHR is Possible

Posted on August 30, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week I had a rare healthcare experience – something that I had only read about in blogs and on Twitter – a physician showed me what he was entering into him EHR while I sat beside him in the exam room! I’m not ashamed to admit that my first thought was “I can’t believe this is really happening”.

The doctor must have noticed how I quickly moved my seat closer to the large monitors because he chuckled and asked me: “How long have you been in healthcare?”. After sharing a laugh he went on to say “It’s rare that patients take a keen interest in what I’m keying into the system. It’s usually other healthcare people that want to see what’s going on. Are you a nurse or a physician?”

When I told him I was in Healthcare IT field he smiled and said “Ah that would have been my third guess.”

For the next 20 min he would type a line of notes, point to the screen and then share his reasoning with me. I asked him questions on clinical terms that I did not understand, at which point he would bring up a resource that had a definition. If he didn’t have a ready resource, he explained it as best he could and then encouraged me to look it up on a trusted site like Mayo Clinic’s.

Near the end of the appointment, the doctor asked me if I was involved with EHRs. When I asked him why, he said the most intriguing thing – “because it’s clear to me that the people who design EHRs (a) have never actually seen a patient in an exam room – it’s ridiculous how awful the screens are and (b) never thought that one day doctors would sit beside patients to let them see what they are entering.”

The latter statement has been churning through my mind ever since.

There is little doubt that the majority of EHRs are less-than-well-designed. Physicians everywhere complain about the amount of clicking required to navigate their EHRs and the number of fields they have to enter. The prevailing opinion is to improve EHRs by getting closer to physicians and actually studying how they really conduct a patient visit. This will certainly yield positive results.

But what if we designed an EHR that was meant to be displayed on a big screen? One that had screens that the patients would see as the doctor entered his or her notes? I believe that designing for this type of usage would result in a more significant improvement in usability and have a more positive impact on patient experience than building EHRs based on better observation of physician workflow.

Consider the phenomenon of open kitchens in the restaurant industry. For diners, being able to watch the kitchen staff prepare meals helps to pass the time while waiting for your order. It also allows the diner to see how talented the chefs are – because they can see them working. For staff, an open kitchen often means that the restaurant has put a lot of thought into optimizing food prep workflow. After all, no one would choose a layout that had staff constantly bumping into each other in full view of diners.

If a company designed an EHR that could be shared with patients, they would not only improve the interface for physicians, but they would also provide a means for that physician to improve the overall patient experience.

I hope that more physicians adopt the practice of sharing their EHR screens with patients during a visit. Doing so will immediately improve patient experience and will push vendors to improve their solutions at a far greater pace.

Patient Engagement and Patient Experience

Posted on May 24, 2017 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 got tied up on some big projects today and so for today’s post I’m going to point you to some really great resources being shared around patient engagement and patient experience from the Patient Engagement Summit hosted by the Cleveland Clinic.

Here are two images that were shared from the summit which give you a flavor for the types of conversations and knowledge that was being shared at the Patient Engagement Summit.


Note: Adrienne Boissy, MD, MA, noted that the chart above comes from this article.

You can find more great content like this by checking out the hashtag #PESummit on Twitter.

Myth: Healthcare Is Different From Other Industries

Posted on May 5, 2017 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.

If you don’t follow David Chou on Twitter, then you’re missing out on some really great content. This is particularly true if you’re a healthcare leader. A good example of this was the following tweet that David shared:

The topic of whether healthcare is different from other industries is an important one that’s worth discussing. The chart above and the research by McKinsey&Company would suggest that healthcare isn’t all that different from other industries. However, I think there’s a nuance in their reality check.

The nuance is that healthcare have similar expectations of healthcare as they do with other non-healthcare companies. However, that doesn’t assume that healthcare consumers act the same as they do in other industries.

There are great examples of this. When you’re in the back of an ambulance after a heart attack, you’re not acting like much of a consumer. They’re taking you to the hospital of their choice and you’re going to largely get the care that the ED feels you need. In what other industry does this occur? There are other examples like elective procedures in healthcare that are very much an experience like other industries.

What the study illustrated above does teach us is that even if the consumer decision making process in healthcare is different, there are core expectations that we have regardless of how we chose to interact with the healthcare system or not. There are some universal tenants and expectations that healthcare should remember:

  • Providing great customer service
  • Delivering on expectations
  • Making life easier
  • Offering great value

I’ve started to see more and more healthcare organizations worry about these tenants of a great patient experience. When you see it broken out like the above, it sounds so simple. Implementing the ideas can be amazingly tricky. However, this is exactly where I see healthcare headed.

Patients Frustrated By Lack Of Health Data Access

Posted on January 3, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new survey by Surescripts has concluded that patients are unhappy with their access to their healthcare data, and that they’d like to see the way in which their data is stored and shared change substantially.  Due to Surescripts’ focus on medication information management, many of the questions focus on meds, but the responses clearly reflect broader trends in health data sharing.

According to the 2016 Connected Care and the Patient Experience report, which drew on a survey of 1,000 Americans, most patients believe that their medical information should be stored electronically and shared in one central location. This, of course, flies in the face of current industry interoperability models, which largely focus on uniting countless distributed information sources.

Ninety-eight percent of respondents said that they felt that someone should have complete access to their medical records, though they don’t seem to have specified whom they’d prefer to play this role. They’re so concerned about having a complete medical record that 58% have attempted to compile their own medical history, Surescripts found.

Part of the reason they’re eager to see someone have full access to their health records is that it would make their care more efficient. For example, 93% said they felt doctors would save time if their patients’ medication history was in one location.

They’re also sick of retelling stories that could be found easily in a complete medical record, which is not too surprising given that they spend an average of 8 minutes on paperwork plus 8 minutes verbally sharing their medical history per doctor’s visit. To put this in perspective, 54% said that that renewing a driver’s license takes less work, 37% said opening a bank account was easier, and 32% said applying for a marriage license was simpler.

The respondents seemed very aware that improved data access would protect them, as well. Nine out of ten patients felt that their doctor would be less likely to prescribe the wrong medication if they had a more complete set of information. In fact, 90% of respondents said that they felt their lives could be endangered if their doctors don’t have access to their complete medication history.

Meanwhile, patients also seem more willing than ever to share their medical history. Researchers found that 77% will share physical information, 69% will share insurance information and 51% mental health information. I don’t have a comparable set of numbers to back this up, but my guess is that these are much higher levels than we’ve seen in the past.

On a separate note, the study noted that 52% of patients expect doctors to offer remote visits, and 36% believe that most doctor’s appointments will be remote in the next 10 years. Clearly, patients are demanding not just data access, but convenience.

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.