Reinventing The Patient Experience

As I was going up the stairs, I met a man who wasn’t there.

Then I read an article espousing the ROI of EHR. I leave it to you to decide if these two activities are one in the same.

I also read an article on reducing readmissions in this month’s HealthLeaders. Perhaps it is because my synapses do not work the way they were intended to work, but the first thing that came to mind for me was, how could patient experience be reinvented to help contribute to the goal of reducing readmissions? Could deliberately coloring outside of the lines help to solve a real problem?

It absolutely can. One reason patients readmit is because of their failure to comply with their discharge instructions. They do not do what they are supposed to do, they do not do it with the frequency with which they are supposed to do it, or they do not understand what to do, who to contact, how to contact them or when when something goes akimbo. And worst of all, nobody at the hospital knows anything about these failures until the patient is readmitted.

Many of us have been discharged. I remember the discharge process as the only thing standing between me and the front door. I would have nodded to anyone and signed anything to be home and to have the hospitalization behind me. I would read the fine print once I was paroled, once I had a real television remote in my hand, not some off-white three-channel device that was tethered to the hospital bed. Is it possible that more than a handful of patients feel this way?

Since you cannot give patients a test to confirm they understand their instructions prior to discharging them, and you have no control of patients once they leave, is the situation hopeless?

Patient experience continues once patients are discharged. Or it could. Post discharge, most patient experiences — and family experiences — consist of calling the hospital for a variety of reasons; understanding discharge instructions, scheduling a follow-up appointment, scheduling a lab, understanding a bill, filing a claim — reasons very similar to those encountered by patients before they are admitted. Unfortunately, the people being called may not know the right answer to any of these questions. Unfortunately, the line may be busy; it may be after hours, or during the lunch break. Access 8 a.m. until 6 p.m.

They call the hospital. How well did that work? If the answer is not well, they may be on their way to having a very poor experience. If it concerns their discharge instructions they may be on their way to being readmitted.

Here’s how we can tie reducing readmissions to patient experience. It is not complex, it does not require and MD or a PhD, and it is not really all that innovative unless innovation means looking at solving the problem in a way that differs from the way solving problems is normally looked at.

It is all about access, two-way access. Two-way access between the hospital and the patient. Digital and mobile access. Twenty-four by seven. I know you do not do it this way, and the natural reaction to this idea is that some of you will have a long list of reasons why this cannot be done or why it will never work at your hospital. It won’t work for people who do not want it to work, or who may not have the skills. One invalid excuse for it not working is not because it cannot be done. It can, someone just has to tell someone to make it happen.

Let us take a non-natural reaction, just for a minute. I envision the following — this is not exhaustive, it does not come from hours of research. It is just a back-of-the-napkin idea that I would like your opinion as to whether it is worth another napkin or two.

What if the complete discharge summary, and everything patients needed to do, could be available to the patient and the primary care provider in real-time, at the time of discharge? What if the patient’s behavior and compliance could be recorded, tracked, and reported? Online access. Perhaps on an iPad type of device. Let’s use me as an example, me, the guy who was in too big of a hurry to get discharged to pay attention to my instructions.

Now that I am home I read the instructions. I register on the website using some form of secure ID that pulls up what I need. I read about my medications — what they are for, when I have to take them, possible side effects. I discover that I can track my recovery progress on the site, enter when I take my meds, record when I may have exercised or gone to therapy, perhaps enter what I ate, my blood pressure, and weight.

Maybe my wife logs in and helps me schedule an appointment, therapy, or a lab. If I schedule a lab the site tells me my instructions prior to having the lab work done, and I provide an electronic signature to confirm my understanding of those instructions.

If I have questions I use the online chat function, or I submit a question that will be replied to within an hour.

My primary care provider can access my progress.

This is certainly not an exhaustive list of tasks, and it deserves more consideration than the twenty minutes it took to write this post. However, if you pair the idea of decreasing admissions and increasing access, and do so using user-centered design to create an intuitive user experience you may be surprised by the results.