The lament is so commonplace, and so seemingly intractable that it should probably be something you can place on an insurance code sheet. "Not enough time" would have to include sub-codes, as well: a) to talk with patient, b) to confer with other doctors, c) to research the case, d) to set up thorough, well-planned follow-up plan. Patients have already embraced the Internet as a way to wrest back some control over their medical care. "We're seeing more and more patients who are doing research [on their symptoms, conditions, and medications] beforehand, which is a real shift in patient behavior since we've had the Internet," said JimFaircloth, a manager with the Atlanta-based Coker Group, which consults on practice management.
And younger doctors, especially, are welcoming patients who've done some homework in advance, Faircloth adds. They recognize that knowledgable patients can improve the quality of communications in an office visit. An increasing number of doctors are embracing the Web and providing links to resources on their practices' Web site, saysFaircloth.
This is good, but not good enough, according to a 2006 Wall Street Journal Online/Harris Interactive Poll. The simple, clear, and accurate headline used by Harris to publicize the results almost tells the whole story. It reads, "Few Patients Use or Have Access to Online Services for Communicating with their Doctors, but Most Would Like To."
Patients certainly want that high-quality in-office interaction. But they want much more: 77 percent want appointment reminders by email, 75 percent want to be able to schedule their own appointments online, 74 percent want to be able to communicate directly with their doctors via email, and 64 percent want access to their EMR.
The bad news is that few patients had access to these services in 2006, and not much has changed in the past two years. "I haven't seen a lot" of practices providing these, saysFaircloth.
The good news is that vendors of practice management systems now offer inexpensive patient communication add-ons that can be built into, via Web 2.0-style front ends, existing practice Web sites.
Patients are clearly ready. But, says Faircloth -- specifically referring to online scheduling -- "The mindset has to change. I think the smaller practices are quicker to embrace it than larger practices." Smaller practices, he suggests, are more nimble in regard to making changes such as this, simply because fewer doctors means fewer in-house political problems and less red tape.
Systems that automate crucial and time-consuming patient communication aspects of running a practice make more sense now more than ever. By embracing new technologies for automating appointment reminder calls, providing alerts to both patients and doctors when prescription refills are needed, and giving patients the ability to schedule their own appointments and review their own health records, practices can both satisfy the demands of the majority of their patients *and* ratchet down costs by reducing bottlenecks.
Other common practice bottlenecks that can be cheaply automated while improving patient communications:
- On-line medical history questionairres that patients can fill out at home and either submit electronically or print out and bring to their first visit;
- Basic patient information sheets that include contact and insurance information;
- Lab results or alerts that results are available via phone;
- Prescription refill requests;
- Reports (including complaints) that patients can submit online prior to visits.
The Allscripts Access Online Patient Portal (produced by A4 Health Systems, a Raleigh, NC-based division of Allscripts) provides these capabilities, as do many other large ASPs (Application Service Providers) in the healthcare market, including GE Centricity and Sage Software.
While adopting and adapting to new technologies is and will continue to be a big challenge for small- and medium-sized practices, a more difficult task lies in keeping the personal touch even in automated communications, warns Chris McConnell, the co-founder and President of Adondo Corporation, which delivers targeted messages for customers via its Phone Portals system.
The system, says McConnell, provides patient communications for many clinical studies, delivering information on protocols, study updates, and appointment and medication reminders. He says that it's crucial that calls are "welcomed" -- in other words, wanted by those who receive them.
In addition, audio messages must be introduced by "a friendly, recognizable voice," although almost by definition most of the messages are delivered by synthetic voices.
Finally, McConnell recommends that the recipients have control over how (and where and when) messages are delivered. Patients should be able to choose to receive appointment reminders via e-mail, text message, or phone, for example. The more control patients have over the process, the more they like it.
WHAT YOU CAN DO NOW
While there's probably much that your practice can do to improve patient communications, the modular nature of current practice management systems means that you can roll out automated services one at a time. That gives both you and your patients plenty of time to adapt to the change and work out any unintended consequences.
And, as Andrew Stewart wrote in a recent CokerConnection newsletter article, "Installing one or more of these applications in a practice’s website can make a tremendous improvement, both in office efficiency and in patient satisfaction."
