Keeping Up with Dr. Jones

MDNG Primary CareMarch 2011
Volume 13
Issue 2

Other industries are using smartphones, tablet PCs, and the Internet to propel their businesses into the future. What can you do to keep health care from falling farther behind?

Other industries are using smartphones, tablet PCs, and the Internet to propel their businesses into the future. What can you do to keep health care from falling farther behind?

By Amit Bhavsar, MD

While performing a routine task like booking a vacation online or reserving a dinner table with your smartphone, have you ever found yourself wondering how technologies that make it so convenient to do these things can be used to make your clinic more efficient? Would patients appreciate the same capabilities they have come to expect when they search online for product information or manage their finances, functions that arguably are just as vital and personal to them as their health care?

What technologies exist today that, in an ideal world, could be capitalized on to make interactions in our offices better for our patients? I’ve summarized several concepts here, basing my ideas on concrete examples from other industries that have managed to create positive user experiences for their customers. I believe the first step toward improving the patient experience is to create a vision that will dictate the rules needed to make it come to life.

Web presence

Let’s begin with a feature that is most familiar to people: the business website. For many primary care clinics, their website is an afterthought; they have put far more thought into their reception area, waiting room, phone system, and conventional advertising media. But I would argue that the quality of a clinic’s website is far more important than any of these considerations, as attention here will pay far greater dividends.

For example, before purchasing an item or service, many people will conduct at least a cursory Web search to determine what other customers have said. More importantly, many potential customers will first visit a business’s website to obtain not only basic information, but to determine what can be done without visiting the establishment. Imagine doing business with a bank that does not have a website. By now, most of us expect banking to be conducted through our smartphones and tablet devices, as well as Internet browsers.

Incidentally, I have been with the same bank since 1996 and have never stepped foot into one of its branches. I have done everything via phone and Internet. In the same light, a clinic’s Web presence is literally its virtual storefront to the world. Most of us can understand paying top dollar for prime business real estate that will convey a certain message to our patients. The same principle applies to your business presence in cyberspace.

But these days, it is not enough just to have a nice-looking website. The website must allow patients to do everything they possibly can without calling or coming into your office. Patients should be able to make, cancel, and reschedule appointments; send messages to the receptionist; print out work and school slips with their appointment date/time on it; and drop their next appointment into their digital calendar with a click or a tap. Patients should also be able to e-mail their doctor.

Yes, there is that whole can of worms regarding reimbursement; however, this level of service is something that patients will expect, and in many cases, even be willing to pay extra for. Imagine if, after scheduling an appointment online, your patients were directed to a page where they could enter their personal, medical, and insurance information instead of having to fill out a pile of paper forms when they came to your office? Imagine: No more lost insurance forms or repeated requests for the same information, plus you’d also get more efficient waiting-room flow.

It would not only make your patients happy and feel respected, but workflow for your front desk would be dramatically improved. None of these capabilities are novel and all are being utilized by other businesses today. Instead of hunting for patient information forms, you can tell your patients that the required information is already in their e-mail inbox and has links to specific websites for further information. Then they’d have your e-mail address for asking any questions. Another benefit to workflow!

Face to face

In March 2010, Facebook surpassed Google to become the most popular Web destination in the United States and is currently number one in the world ( The significance of this is that many patients expect to be able to link with just about every establishment they do business with via Facebook, including their doctors. This certainly lends itself to debate regarding the role of social networking within the context of the doctor—patient relationship; however, one cannot circumvent the reality of this new paradigm.

“How can this benefit me?” you may ask. Since many of your patients probably check Facebook more often than their e-mail, Facebook provides a great venue to push out general information in near real time. Your patients will appreciate you actively providing information and your ability to react to changes quickly. Imagine the decreased call volume if basic information is actively pushed to, instead of being pulled by, your patient population. For example, changes in clinic hours, announcements regarding a new doctor on staff, and new capabilities can all be pushed to your patients to instantly appear on their Facebook page. These updates are free and quite easy to set up, thus saving you and your patients countless hours through improved and timely communication.

In addition to the communication benefits, this establishes a virtual relationship between patients and their doctor, much like the relationship between networked “friends,” many of whom don’t meet on a day-to-day basis but still remain closely connected

through status updates and postings. Although data are lacking, it is reasonable to deduce that such contact could help patients better appreciate the medical home concept and identify readily with the doctor’s office they are linked to via a social network.

Get your head in the clouds

Although it is sometimes overlooked, networking with your colleagues is just as vital as networking with patients; the utilization of technology to ensure solid coordination of clinic operations is just as important as your external Web presence. Enter cloud computing, which is based on the premise that information does not reside on a single computer, but on whatever device is in front of the user. In many cases, that may be a phone or tablet device. Files can be shared among multiple users and are instantly updated for everyone.

One application of this involves shared calendars to coordinate multiple schedules. For example, say you have 10 physicians on staff. Using a cloud-based calendar application such as Google Calendar, a clerk is able to see everyone’s schedule at the same time to ensure there are no conflicts and overlay nursing schedules to ensure adequate support, viewing as much or as little detail as required. The real beauty is that any changes will instantly be reflected on everyone’s calendar.

Smartphones and tablets

Unfortunately, not all technologies used in the clinic are fulfilling their promise. For example, the current capabilities of EHRs leave much to be desired. Due to a variety of factors, much of the technology currently used in the exam room and at the bedside woefully lags behind the cutting edge. In my government clinic, I am mandated to use the Armed Forces Health Longitudinal Technology Application, a legacy of 20th century software with countless layers of patches that have left it so bug-ridden that it is the single greatest limiting factor to productivity in what is arguably the largest medical network in the world, the US military health care system.

Instead of being hindered by such dinosaurs, today’s clinics should be utilizing the rock-solid stability of tablet-based hardware platforms running EHR apps that fully leverage their capabilities. In my clinic, adding a photo to a patient record takes many steps and is a formidable task. Tablets make such tasks much easier. One simply needs to hold up their iPad, snap, and press a button to integrate the photo. The same holds for video. Who says that a patent’s gait has to be described when it can be captured in high definition and placed in the chart?

While we are on the subject, one click can take an e-mail or text message off an iPad or smartphone and turn it into a patient encounter that is added to the patient’s chart in all its billable glory. A single click can send your patient information that is germane to their visit and is waiting for them the next time they check their e-mail. The coders will scream and yell, but if we wait as an institution for the bureaucratic hurdles to topple, we will never evolve. Technology waits for no man and will leave many in its wake.

What are the implications of all this? Well, not using these technologies has clear implications regarding ease of use for our patients, which ultimately will drive them into the arms of McClinics based on nurse practitioners, which will readily embrace such technology in hopes of attracting their biggest customer base, those looking for convenience and speed. Failing to deploy essential technology will severely limit some clinics to a very limited base of loyal customers who may be willing to put up with the hassles of the old way of doing business.

There are many challenges ahead, not the least of which is figuring out how to remain HIPAA-compliant or how to bill for the increased workload that may be brought about due to increased productivity. It was only a decade ago when physicians finally adopted personal digital assistants (PDAs) and began moving toward paperless practices. New technology is again driving change. This will promulgate a new shift in medical practice, just like the previous shift from office libraries to PDA libraries. Unfortunately, if we reject this, technology will clearly continue to progress and our profession will continue to be left behind. At this point, it is not even about keeping up; it’s about catching up before the next big technological tectonic shift.

Dr. Bhavsar is an associate professor of family medicine at Tripler Army Medical Center, Honolulu, HI.

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