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Can the DMV Point the Way to Better Service?

Doug Thompson from The Advisory Board Company's IT Strategy Council used his recent adventures in disconnected healthcare to pen What could hospitals learn from Amazon.com? (And) Why even the DMV could teach us a lesson.

The article is members-only, but I'm reproducing it here with Doug's permission.  Implementing Doug's recommendations wouldn't cost a typical hospital or clinic a lot of money, certainly nothing like that fancy new EMR where customer benefit is either assumed or incidental.  Mostly what's needed is a change in emphasis, from what benefits ME as provider to what benefits YOU as my customer.  (Note that the emphases added are mine.)

"August 19, 2011, Doug Thompson, IT Strategy Council
"Thankfully, my recent colonoscopy screening was routine, and I was back at work the next morning. Nevertheless, the process itself was uncoordinated, inefficient, and lacked a customer focus—a stark contrast to common practices in other industries. The experience left me thinking: What could hospitals and their CIOs learn from Amazon, American Express, and others?

"The initial office visit: I like to stay on top of things: pay my bills before they are due, keep up with the lawn, meet deadlines at work. But it was still surprising that I had to remind my physician that I was overdue for a colonoscopy—in fact, I was two years late.

"How could this happen in a world where Amazon.com sends me tailored reminders about things they think I might buy? Were my expectations unreasonable? Or is our health care system out of touch with modern life? My screening would give me plenty of other reasons to consider these questions…

"The referral: My physician referred me to a gastroenterologist who didn’t use an EMR system in his office, so I filled out all the same paperwork and repeated the physical exam. While waiting, I booked a flight through one airline on a “code share” with another airline. The details were seamlessly and automatically transferred to the second airline’s system–-no duplicate data entry required.

"The gastroenterologist’s office later called to move up the time of my procedure due to a cancellation, but I never received an electronic confirmation of the original appointment or the time change. My airline schedule, on the other hand, is archived in my inbox. If my flight is canceled or delayed, I will automatically be updated via email and text.

"The check-in: When I checked into the hospital for my procedure, I wrote my name on a slip of paper, which was several minutes later carried by a volunteer into a nearby room for processing, for greater privacy. I realize that health care providers are feeling nervous about security, but there are more efficient and effective solutions. When I book a hotel, I pre-enter my personal information online, and it’s instantly confirmed at the check-in desk without any forms.

"During registration the financial counselor asked for $800, although screening colonoscopies are 100% covered by my insurance. After half an hour of confusion, we learned the gastroenterologist had submitted a more costly billing code in case he had to remove polyps during the procedure. His office said they’d refund our money if he didn’t find anything, but I wondered whether he would look really hard for something to take out to justify the code. Imagine prepaying the hotel mini-bar in full—just in case you need those seven sodas and five snack packs!

"In yet another contrast, American Express earns my loyalty with billing and dispute resolution systems that put my interests first and ensure satisfaction with card purchases.

"Waiting for the procedure:  After I searched in vain for the status of my procedure, waiting room volunteers explained that colonoscopies like mine were not included on the outpatient surgery center tracking board. However, even the Department of Motor Vehicles gives me a number that I can track on screens throughout their waiting room--no matter what sort of vehicle I am registering.

"Later, I undressed and waited for my colonoscopy in an empty room full of stored mobile devices. As I was being wheeled into the actual procedure room, it dawned on me that even my health club doesn’t have me change clothes in the equipment room.

"Post-procedure: I did not see the doctor after the procedure and a month later I still have not heard anything from the gastroenterologist or my primary care physician about my results. I did, however, just receive a personal note from the owner of a furniture store where I once bought a chair.

"I wanted to share this story because health care organizations must improve the customer service they provide. As patients exercise more discretion about their providers and providers are rewarded for patient loyalty under accountable care, now more than ever, it is imperative that we evaluate ambulatory surgery processes from a patient’s perspective.

"Listed below are four items many patients do not consider a luxury:

•Connected EMRs for employed and affiliated physicians;
•An integrated patient portal including scheduling, PHR link, reference information, and two-way communication capabilities;
•Electronic pre-registration and check-in capabilities linked to clinical and business systems; and
•Physician e-mail communications with patients."

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