The provider-patient relationship used to be one-sided: the provider diagnosed and dispensed care, while patients had to navigate phone systems, paperwork and arcane processes just to make an appointment. Improving the patient journey has led to outcome-based, value-based care and a culture where consumers are taking a more active role as partners in their own care.
With the emphasis now on patient experience, technology is beginning to support these changes, but there’s still a long way to go. To examine the issues and challenges, as well as where the industry is going, we talked with Michele Perry, CEO of Relatient, for the Healthcare IT Download podcast. She brought both the opportunities — and the obstacles — of a rapidly-shifting landscape into focus.
Future Healthcare Today (FHT): How does technology factor into patient experience and what are some of the technologies that are changing the equation?
MP: People really start to focus on the patient journey and that journey includes everything from the very beginning of getting an appointment. We’re used to being able to quickly do things and that’s not how it’s been in medicine until recently. So, it’s starting to be, “How can I quickly get an appointment?” I want to make an appointment at 8:00 at night, I realize, “Oh, I want an appointment for two days from now.” And you haven’t been able to do that. You had to call during work hours, and don’t call during lunch because the phones are off and they’re sending you to an answering service.
Instead, people want to be able to easily schedule, they want to get the confirmation. I always use the example of, “I was getting confirmation about hairdresser appointments before I was getting confirmations about medical appointments” — which one’s more important? So, it was really important to have that.
Why they were delayed was because we had integrated the back-end medical records, and there were all these new rules around HIPAA and everything before you could just do patient reminders. So, it’s important to be able to have that whole journey, everything from doing e-registration and getting your insurance into the system and being able to, after the fact, easily pay your bill online and being able to do surveys about your practice — say you had a good experience and endorse the practice or you didn’t have a good experience and notify them and let them do some kind of service recovery.
That full circle is what’s really changed over the last two years; it’s that people are starting to really focus on that. And that’s driven by some of these quality initiatives that are out there. It’s driven by the whole consumerization of health care. If you look at what’s going on in the last year with companies like Amazon getting into the market with the acquisition of PillPack, with the CVS-Aetna merger and things like that, there are big changes underfoot and practices are realizing that they’re going to be left behind if they don’t really focus on the patient journey and making it easy that way.
FHT: It used to feel like there was a barrier, a wall between patients and doctors. You couldn’t view your own records. You’d sit forever in the waiting room because the doctor’s time was more valuable than yours – at least that’s how it felt. And now you’ve got portals with records access and online appointment setting and ways to communicate with the doctor outside of the exam room. Tell me more about the change in attitude.
MP: I want to defend the doctors about why they sometimes had you waiting there. Part of the reason they had you waiting is that “no-show” rates were up to 20 percent, even higher in some practices. So many people were no-shows that the doctors would basically overbook patients. And so, by really focusing on bringing that down and reminding and have the best practice on how often you remind patients, you’re able to bring those practices’ no-shows down to more like the 4 percent range, if you do it right and work with a trusted provider. That’s why we’re all sitting around doctor’s offices. They were overbooking because of the no-show problem.
FHT: Is there a risk of running before you walk? What are some of the pitfalls for practice managers as they try to incorporate technology into their practices and organizations?
MP: One of the things we say around here is, “To do what we do is easy, to do what we do right is really hard.” I think the risk is, you could go with an easy method as opposed to a right method. You have to make sure that you get something that’s really integrated into your EHR and practice management system. And that’s the Achilles heel of the whole healthcare industry: tying into these systems. There’s no standards out there. There’s some starting to come, with the FHIR API and things like that. But that’s still really early. So, integration and doing the integration right is key. We’ve done over 86 back-end integrations like that now and no two of them alike, because these systems were done so different, basically.
The second thing is compliance and that’s a huge thing for these. All these rules are there to protect patients: CAN-SPAM, about your e-mailing, the TCPA guidelines for texting, HIPAA for privacy, and making sure all of those are being followed and being compliant. If you buy a lot of different products, you might be sending texts out from different products that would violate TCPA.
So, you want to make sure that you’ve got a system that’s integrating across that and managing and making sure that you’re compliant across all of those.
FHT: Security and confidentiality are absolutely crucial, not only because of HIPAA regulations but because we’re talking about the kind of information that could be harmful to patients if it gets out into general release. So, are there technological ways to protect that that confidentiality that practice managers need to employ?
MP: I always say you should be augmenting your patient portals. People made big investments in the patient portals and those are some secure places that just aren’t being accessed very much. So, augment that with a good patient communication platform. That can make it easy for the patient, to be driving them through texts and voicemails and e-mails easily to the portal to get things accomplished. It will make sure that all these things are in compliance, make sure that they’re all doing all the security guidelines, the HIPAA guidelines and all of that.
So, make it one integrated patient journey. It can tap into the patient portal and any investment you made there, but it should be one patient engagement platform. And again, this should be a trusted platform. We see companies coming out with really cheap ‘we can send a text’ (products) — anyone can send a text, but make sure you get a trusted vendor with their trusted platform that’s doing lots of volume, that’s got the kind of security and all the different things in place to make sure that your clients and your data is safe.
FHT: True, a poorly implemented portal is no better than no portal at all at all. Security needs to be baked into all these solutions. Are you seeing that at the root of all the technologies that are being developed?
MP: I’d like to say it’s at the root of all the technologies, but unfortunately, it’s not. It is at the root of our technology, very much, and is one of the things we use to differentiate us in the market. It’s very different than some other sectors of the market. We’re following all the different compliance things, whether it’s CAN-SPAM, TCPA, and HIPAA – all of that is really an essential piece of what we do with an integrated system across all the different communications channels. So, yes, that is something we take very, very seriously.
FHT: How do practice managers avoid problems and get the most out of their investments in new tech? What are some other ways that they can improve things?
MP: We say, it’s not just communicating with patients but it’s making sure that you’re documenting and time stamping these communications and most importantly, that it’s reportable. So again, if you want to go after any of the different money and compliance things under MACRA or MIPS or patient centered medical home, all these different things that require you to be able to report exactly how you communicated, when you communicated, who’s communicated and everything over the patient’s journey there… so again it’s not just sending a text — that sounds easy, that’s the easy part of the business. It’s all the back-end integration and reporting that comes with it.
FHT: There are a lot of healthcare systems that promote telemedicine in some ways. Can this all tie into those back-end systems?
MP: Absolutely, because telemedicine requires appointments, it requires all the same information, as far as being able to record when you’ve seen patients and be able to interact with the patients and have follow-ups, so telemedicine is an essential part of the patient focus going forward.
FHT: Michele – let’s talk about where things are going. The patient-centric focus has led to some transformative technology. We’ve seen that with portals and the patient communications systems that you’ve been championing. Are there more of these transformative changes on the way, or should we expect more of an evolution from the industry?
MP: We’ve started the transformation and I think you’ll see more and more of this patient-centered communication coming out. I think you’ll see a lot of the other technologies that you’re seeing in other businesses starting to appear in healthcare. You’ll see more bots, you’ll see more AI, you’ll see other technologies like that, which will allow us to really focus on the patient and make it easy for the patient to do the hard part of getting to the doctor, getting their data, staying on care plans and everything that goes along with it.