Transforming the Patient Experience
Simone was preparing for her follow up with her physician. Six months ago, Simone was exploring the cyberspace for a specialist. She had chanced upon the provider website and was pleasantly surprised. It was open and transparent- there was information on both cost and quality of procedures and providers.
She signed up online and now had access to services through a patient portal. She had access to available appointments of physicians as well as information on procedure costs. Her portal was personalized. She could see for her procedure how much of the charges would be paid by Insurance and how much she would have to pay. She even had creative financing options. She could see what her deductible would be as well as the deductible balance. She had set her preference for notifications via Text; she would get reminders of her upcoming appointments.
Her personalized portal showed her the clinical journey she was on, as well as what she should expect in her coming visits. Alternatives at each stage of the intervention were indicated as well as education videos and research papers on the pros and cons of each alternative. She was provided information on clinical trials so she could make informed decisions. She was alerted to events and webinars that could be of interest to her. She was also connected socially to patients with similar conditions. She had signed up for her family to be updated on her journey and the healthcare system promptly messaged family as well as her physician.
What she liked was the option to have after hour visits via Telehealth as well as the ability to include a remote family member during the video consult.
A day before her visit, Simone got an alert with a request to update some missing information, with a link to the form to be used to update the data. Simone logged in and provided the information. She then e-checked herself for the visit. She could check-in through her phone, her laptop, at a kiosk in the facility as well as with a concierge. She could also reserve a parking spot at the facility.
On the day of the visit Simone received directions on her smart phone from home to her reserved parking spot at the clinic. As she entered the parking lot she was greeted with a welcome message on her smartphone and an inquiry if she would like a golf cart to take her from the parking to the clinic. At the door, she was welcomed by a concierge who greeted her by name- had her badge ready and escorted her to a hospitality suite. There she saw a short video on who her attending nurse would be and what she should expect during this visit. A message on her phone indicated that there would be a delay of about 25 minutes and she received a $10 coupon that she could use in the café. She received directions to the café on her phone and a virtual assistant escorted her to the café. She had a free basic internet access on her phone and for a small charge could get premium internet access that would allow her to watch videos or video chat with friends and family.
Simone had barely finished her coffee when her virtual assistant alerted her that her care team was ready to see her in the next 10 minutes. Simone walked over to the lobby and a live concierge was waiting to escort her to her examination room. Her TV monitor in the examination room announced the arrival of her nurse who took her vitals in the room itself and updated her chart. Simone had a view of her chart on the TV screen. Her physician arrived shortly for an assessment and consultation. He was well informed on her condition, empathized with her and recommended some research that he had pushed to her portal, that she should look into. He spent time showing her the MRI’s explaining in terms she could understand of what was the situation. He then e-prescribed medication with an option to pick it up in the onsite pharmacy or the pharmacy of her choice. Simone was well aware that her medication would be filled by the time she reached the onsite pharmacy and she chose that option. Her next appointment was set on the spot and she would receive a text confirming the appointment as well as updating her calendar on her phone.
Reality or fiction?
A recent GE-Prophet study (“The Current State of the Patient Experience,” GE, www.prophet.com ) showed that an alarming 81% of the consumers are dissatisfied with their healthcare experience. The same study shows that 63% of providers overestimate the quality of their patient experience by as much as 20% points. 77% of CEO’s surveyed by the health leaders’ medical council think patient experience is extremely important to transform healthcare, 48% of the organizations listed Patient experience and satisfaction as one of the key priorities for their system.
Value based purchasing models rely on the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) for reimbursing a portion of the services rendered by providers. While there is universal agreement, that Patient experience is critical, there is little guidance on where to start the journey to transform the experience or how to deliver it.
I have been approached by CxO's requesting to help identify a “Zocdoc” or “Uber” or “Amazon” like experience for the patients. Uber is instant gratification and the healthcare system is not yet there to be able to provide that- though there are models such as American Well or MD Live that do provide some capabilities. For businesses, Castlight allows employees to compare healthcare providers across a comprehensive set of metrics including cost and quality. Simplee provides solutions to help with estimates, payments, financing and credit in healthcare.
To provide a retail like experience healthcare system have to transcend the episodic Medical Record Number view of a patient.
Healthcare settings can be integrated or non-integrated adding to the complexity of providing a consistent branded service across the eco-system.
Retail provides money back guarantees for non-performance- in healthcare Geisinger transformed its clinical process, focused on patient care transformation going as far as providing money back guarantees for procedures done in their system.
The reality is healthcare is complex, diverse with multiple touch-points, transactions and services provided in different care settings:
Care that is not synchronized and orchestrated can create friction and customer dissatisfaction.
A good starting point is a Patient 360 initiative- one view of the patient by all care teams who are providing services to the patient in any setting. An EMR implementation conforming to the HIMSS EMRAM model at a Level 7 is a good benchmark to ensure this. Information sharing on a regular basis with non-integrated physicians and care teams who may not have access to the EMR helps in patient care and patient satisfaction.
Retail providers know how to provide exceptional service to their consumers. They have rich data that can be mined to provide a good view of their high life time value consumers, their preferences, what they are looking for. Based on these retailers can differentiate and personalize services as well as make recommendations.
Healthcare too have high life time value consumers- in this case consumers who touch the system frequently and for a long time – chronic care patients, cancer patients, cardiology patients, pediatric patients just to name a few.
Consumers interact with the healthcare system in different roles: as users, as patients and as consumers.
As a user, they use the system – patient portals, contact center for appointments, triage or billing, their touch-points are usually virtual.
As a patient, different care teams touch the patients
As a consumer they consume a wide variety of services- Labs, diagnostics, kitchen, facilities- from a diverse care team and extended care teams such as social services, nutritionists, rehabilitation providers.
Patients have a virtual access to their healthcare system through the website, social media site, a patient portal or the Contact center. These channels provide virtual transactions as well as facilitate the provision of certain services. Most patient portals unfortunately are rudimentary at best providing basic functionality such as a view of upcoming appointments, test results, messaging, medications list and sometimes billing.
The patient portal is where the provider has an opportunity to differentiate, customize and personalize a consumer experience.
A patient portal is an important interface for engaging with a patient virtually.
The portal should provide a single pane of glass through which the patient should engage with the system once they have been on-boarded.
This is where a patient should view their journey, their medications, lab results, medical history, navigate their care pathway and be informed so that they could make informed decisions.
A patient should be able to access providers, view cost and quality as well as have the ability to make, reschedule or cancel appointments, virtually.
They should be allowed to request prescription refills as well as stay educated on the medication they are taking as well as things to look out for as it relates to side effects or any pre-determined allergies.
A blue button should allow a patient to download their health records.
Patients should be allowed to fill their forms, upload insurance information as well as pay their bills online.
The portal should include wellness, lifestyle, nutrition and dietary resources.
A “may-day” functionality with a virtual contact center operator available 24x7 should guide the patient if they are stuck in any part of the portal.
The contact center is a nerve center for most virtual interactions with patients and families, whether it is for appointments, cancellations, rescheduling, billing, triage or follow up. Navigating the IVR tree and hopping from desk to desk answering the same questions over and over again can be an extremely frustrating experience.
When one logs on to Amazon, Amazon knows who you are, what your preferences are, what you were searching for, what you bought the last time, what other people bought in addition to the item you bought.
Is there a way to make the Contact Center experience like Amazon in some ways?
At one healthcare system, the EMR, in this case EPIC, was integrated to the Contact Center. When a patient called in, their phone number was matched to a record in the EMR. That provided patient demographic information as well as Clinical context and allowed the call to be intelligently routed to an appropriate desk. The Agent received Cue cards with the patient’s demographic and clinical context, the last visit, the physician and nurse that met them and the system even provided the Agent a pronunciation of the patients/physician/nurse name. The Agent also received the weather at the patient site, a mashup also provided all healthcare facilities and services available near the patient’s home. The Agent could have a friendly conversation and be able to direct the patient to a nearby facility as well as secure an appointment there. Around 85 plus nurses are using this for virtual triage of patients. It took 10 seconds to get relevant patient information as opposed to 70 seconds before the integration, call times were much shorter and the patient experience dramatically improved.
Any learning on a consumer preference whether through a virtual or a face to face interaction should be captured and should feed into enhancing the User experience.
What do consumers in Healthcare really want:
Consumers have an expectation that the care teams “knows them” by name and healthcare condition(s) not just by a MRN and an episode.
The care teams should be able to pull up a 360 degree view of the patient and their context- when they visit the facility through any channel virtually or face to face.
A patient portal is a first step to enable healthcare consumers. Every effort should be made to encourage patients to sign up to the portal and provide a personalized, customized and differentiated experience through the patient portal.
The services through the portal should also be made available through friendly smart phone Apps.
Consumers need to be engaged. Care coordination or discussions on diagnostic tests could be done through Telehealth.
Patients need to be reminded on appointments, medication adherence, or socially connect “like patients”.
Incentives can be provided through coupons, gaming. Consumers should be able to request refills or set their appointments or pay their bills friction free.
For in-patients, bedside engagement through a video solution that shows schedules for the day, treatment progress, entertainment and educational videos, be able to order food, indicate pain levels, request services, video chat with care teams or family or simply listen to soothing music or be able to set the heating in the room or the lighting color/hue or intensity should be provisioned.
Patients feel engaged when they are are aware of their situation, are aware of the care teams managing them and are armed with information such as videos showing what to expect before any medical intervention or stage of their journey in the system.
Consumers feel empowered when they have complete, accurate and reliable information to make the right choices rather than having to make them through instinct. The patient portal should provide informed decision making capabilities, educate consumers on the treatment plan, progress, treatment journey as well as information and options at each stage in the journey with all pros and cons.
Conditions such as cancer are complex with multi-disciplinary teams providing care. Having a care coordinator or navigator who coordinates care as well as navigates the patient through the healthcare system dramatically improves the patient experience.
Patients have been “trained” to expect delays in any healthcare setting. Process improvements can minimize these delays, care teams receiving notifications from the EMR after every event, information made available at the point of care, prompt collaboration between care teams or monitoring and calibrating the the patient door to door process; informing patients about expected delays helps mitigate the “waiting for what” anxiety.
Consumers have needs, many are unmet. There are basic needs, expected needs or transformational needs. A patient journey helps understand the friction patients feel in their interactions with the system. Human centered design approaches can be used to understand these needs.
Human Centered Design approaches for transforming patient experience:
Patients can be segmented by severity of a condition or by the condition itself (such as cancer patients) and the frequency of interactions with the facility.
There are some patients-infrequent users of the system- episodic minor illness patients.
There are the Acute patients- heart surgeries, hip or knee transplants and other major surgeries. Patients with advanced illness frequently use services in the ICU or ED.
There are the Chronic patients who consume services more often from almost all healthcare settings.
Model a few personas based on high life time value and understand lifestyles, their values, their health conditions, their preferences, their tolerance for technology and the channels they prefer to communicate with the system. A journey map is modeled with the stages in the journey, the frictions, challenges observed or opportunities for improvement as well as perceived experiences at each stage.
Journey maps help identify the use cases. Use cases should be prioritized by value and ease of implementation, picking up first the use cases that have a moderately high value and are easier to implement. Success drives success. A good approach is to look at foundational use cases that are common to all personas. Some simple ones:
Enhanced services in a patient portal
E- Scheduling or improvement in the scheduling process
Improvement in the check-in process to eliminate queues
Virtual forms for providing needed information
The list can go on.
Where does it all begin?
Mission statements should include patient and family satisfaction as an imperative.
Structures: Care teams should be enabled, engaged and empowered to drive patient satisfaction and improve outcomes.
Systems: Re-examine systems to leverage technology as much as possible in the quest to drive patient experience. Ensure that technology seamlessly blends into the process with very little learning curves
Strengthen patient portals to provide the glue to enable, engage and empower patients. Portals should personalize, customize and differentiate experiences.
Build intelligent contact centers that empower care teams to engage with the patients.
Clinical decision support systems, machine learning, virtual reality, gaming – tools that can be leveraged for proactive care as well as improve patient experience.
Deliver information at the point of care to engage care teams in delivering quality superior care.
Identify all use cases that will transform patient and family experience.
Map the processes and patient touch points with the care teams. Eliminate lean waste in process and ensure technology eliminates open loop and passive events and converts them to closed loop active events. Blend technology into the process.
Understand the root cause for patient dissonance- which part of this is due to process issues, which part is caused by people issues and how tools and technology can be leveraged to mitigate the friction in the process.
All process that touch the patients should ensure a compassionate, family centered and personalized patient experience. Eliminate lean waste and improve process performance.
Establish a governance to track patient satisfaction.
The good news is that healthcare systems are making a conscious effort to focus on improving patient experience. Some such as Geisinger or Nemours have made giant strides with a committed focus on patient and family experience.
Healthcare providers may be behind than most verticals such as retail or financial services, when it comes to leveraging technology for transforming experiences. Give it some time, five years from now healthcare may well be ahead of most verticals. Consumers are ready for it, it's time the healthcare systems stepped up.