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Tuesday, January 12, 2010
Giving Patients the Tools to Manage Health Care
By Amy Schwartz, Associate Director
New Hampshire Institute for Health Policy and Practice
In early November, my husband and I bought a new minivan. A couple of weeks ago, I got an email. It was time for my first maintenance check, and the dealership sent a link for me to log in and make an appointment. I viewed the entire schedule and selected a day and time that worked for me. I then received a confirmation email moments later and added it to my calendar. I checked my iPhone application as to what the estimated first “check-up” should cost, and I was in and out of the dealership in an hour, knowing how much of a check I was going to be writing. And they had coffee and CNN.
Compare and contrast that, if you will, with my latest health care experience. Just before Christmas, I had to get a minor medical test. Per my detailed instructions for the appointment time I was given, I arrived at 8:00am to register and check in. I had to stand in line, in order to sign up to register. Once I was called in to register, I was directed to one of four people doing registration at the outpatient hospital center, each in their own private room, due to HIPAA regulations. This is laudable except each patient receives a computer-generated bracelet to wear, indicating name, date of birth, PCP and health care record number. These bracelets are probably a good idea as to avoid amputating the wrong leg or administering chemotherapy by mistake. However, a note: the bracelet included almost all identifying information—even ordering physician—but excluded which test or procedure he had ordered (unless of course, it was the only coded piece of information listed). My fleeting thought was that if I were to clip it off and throw it away in the bathroom trash can on the way out the door, someone could emerge with my identity soon thereafter.
I finished registering and proceeded to the temporary waiting room for radiology. Then, I waited. And I waited, for over an hour. This is because, according to the radiology department, my physician’s office never faxed over the orders. So, I wanted to ask, how come the ordering physician’s name was on the bracelet? And why was anyone faxing anything? Faxing is the least secure of any technology. Where did my paperwork end up? And where is HIPAA on that one? However I said nothing, since I wanted to be done sometime before lunch and I sensed making a scene would do nothing to get my appointment underway any earlier. I will admit the fact that this being a fasting test might well have contributed to my grumpiness.
In an age when domestic terrorism has spanned a decade, when just last week a want-to-be terrorist boarded a plane with a panty full of explosives, why am I still able to check in for my flight to Tampa online and 24 hours in advance? Yet my health care system needs to register me twice to make me wait for over an hour because they had to confirm why I was there. When an industry as maligned as automotive sales can schedule appointments online in less than 10 minutes and stick to a time slot, what does that mean for health care? Yes, cars aren’t people. But most standard medical procedures are done day after day, week after week and year after year, allowing for a modicum of predictability.
If one primary solution offered to managing costs in health care is having consumers assume at least some expense and responsibility for their health care status and services, they must be given the tools to do so. We need to have online physician visit forms so that the patient can log in at their convenience, fill in the relevant information and email it back to the staff, so it’s in the chart waiting. I think practitioners would get more detailed answers to “why are you here” if patients didn’t have to take pen to paper. Just think—people might actually read patient consent forms before placing their electronic signature block. Family histories could be filled out and reviewed by a physician for only the relevant genetic predispositions. And patients might be willing to answer more questions or elaborate on an issue, saving time by writing a thoughtful response and making sure the physician understands the complaint and any complicating factors before the appointment. How about online scheduling? The system could be tailored so that a patient can only book the appropriate amount of time. Test results could be emailed with links to important information, saving time, worry and postage. What if a patient could send an email to request a referral instead of leaving it on voice mail? Think of how this one simple move would streamline health care. No more misspellings, incorrect contact information, no confusion about who referred the patient. There would be a paper trail confirming that a referral was requested, maybe even a confirmation back to the patient. You could even copy your insurance company and they could confirm benefits in writing. Maybe I could log in, pull up my child’s (read only) medical record and print off her immunization record for the school. If I were helping to manage an elderly parent’s medical care, being able to log in and check notes and upcoming appointments could ease a long-distance daughter’s mind.
None of this would require a new IT system or sophisticated programs. These ideas are all things a desktop PC can do now, and they are all customer service applications utilized by other industries. Do these ideas have flaws? Of course they do. But the simple fact remains that we have not applied even the most basic technologies to enhance patient convenience and self-management. Want us more involved and responsible? Help the patient by giving us some simple tools to do so.
Tags: Citizens Health Initiative, Health care, HIPAA, New Hampshire Institute for Health Policy and Practice, Patient solutions, Patient tools, scheduling appointments
Fantastic article. I’ve favorited this website so I can follow your follow-ups. Thanks for taking the energy to share this.