- Confirming appointments, sending clinic reminders, and other elements of patient outreach have been the bedrock of patient engagement for some time. As healthcare organizations focus on patient wellness, they are picking up the phone to make sure their patients will attend their appointments and bring all of the necessary information and materials.
But telephone patient outreach has been riddled with inefficiencies that can hinder the patient experience, said Fareed Elhaj, MD, owner of the Houston Thyroid and Endocrine Specialists. The practice, which treats about 20,000 patients total, has found that calling each patient ahead of appointments was simply unsustainable.
“Phone calls were not very efficient because a lot of patients don’t pick up the phone and then we leave a message,” Elhaj told PatientEngagementHIT.com in a recent interview. “But how much information can we really leave on that message? So then patients call back and then they can’t reach us or they leave a voice mail. It’s a lot of back and forth.”
Telephone patient outreach isn’t just a question of time efficiency, either, Elhaj pointed out. In a time where clinics and specialists are strapped for staffers, calling individual patients ahead of appointments has become a significant personnel labor.
“We were sending at least one staff member to spend a few hours every day just doing these confirmation calls, when really the whole point of that was to say, ‘hey, are you going to show up? If you are going to show up, can you make sure to do lab work before hand and relay a couple of piece of information?’” Elhaj explained. “That was a problem that we had for years and then maybe five years ago we started looking into some of these newer technologies.”
Elhaj’s practice was no stranger to emerging healthcare technologies. The practice uses the eClinicalWorks EHR and boasts a respectable patient portal adoption rate. Looking into patient outreach technology seemed like a natural progression for an organization that had always been searching out new technologies to create practice efficiency.
Houston Thyroid and Endocrine looked into patient outreach tools, specifically ones that reach patients using text message, because that medium has recently proven effective among healthcare consumer markets.
Of course, Elhaj and his team could have used the patient portal for these purposes, he acknowledged. But patient portals are not exactly optimized for patient outreach and appointment reminders.
“Most of our patient messaging happens by way of the patient portal,” Elhaj said. “But are all the patients using the patient portal? We actually have a pretty good rate for patients use, but it’s still not anywhere close to 100 percent, so a lot of people are missing those messages. And even the ones that are using it – are they going to look at it in a timely enough way so that they can respond back to it? Do they know how to respond back? Do they care to respond back?”
There are numerous hurdles a patient has to jump through to access a patient portal secure message, Elhaj continued. Patients first receive a notification that they have a new message, and from there log into the portal. If, as Elhaj mentioned, the patient forgot her password, she needs to reset the password. At that point, the patient may no longer be motivated to view the message.
A text message is different, Elhaj stated. These get pushed immediately to a patient’s phone, and with cell phone adoption nearly ubiquitous in the US, this approach seems more accessible for patients.
Providers across the country, including Elhaj, are following suit. Recent data from the Medical Group Management Association (MGMA) showed that two-thirds of healthcare organizations are using text messages as appointment reminders for their patients because patients see their text messages more easily than other messages.
None of this is to say that Elhaj and is team do not use the EHR or patient portal. In fact, part of the appeal of the practice’s vendor of choice – Luma Health – is that it integrates seamlessly with the EHR. This prevents the organization from having to upload patient information each day to send automated text messages, the way it may have had to with another text outreach system.
“That was huge,” Elhaj said. “There was no back and forth in terms of if we wanted a confirmation text sent out. Essentially, if the patient is on our schedule, she gets a confirmation text message. It’s virtually no work for us.”
Patient outreach is more than a reminder message, Elhaj added. The specialty practice is looking into other features on the tool, too.
“The wait list is something that we have been cultivating over the last year,” Elhaj noted. “If there is a cancelation, their text to us changes the color to purple on our scheduler. Then they are put on to a wait list if they choose to do that and if there is another appointment that comes up sooner, then it offers them that appointment.”
This eliminates a lot of the go-between and phone tag that can arise when rescheduling a patient’s appointment.
Elhaj is also working on developing more customizable messages. For example, Houston Thyroid and Endocrine’s pediatric population largely includes patients with growth issues. During consults, it is important for clinicians to have access to a patient’s latest x-ray to check bone age life, an indicator of patient growth potential.
“That is a specific x-ray that’s done often times by the pediatrician before the patients come and see us,” Elhaj explained. “And surprisingly, more than half of these patients don’t bring that information into their first visit.”
Elhaj and his team can put an EHR note on new pediatric patients who have that specific need. Now, each automated patient outreach text message will include reminders to bring that specific health information.
Other doctors may use the customizable messages to prepare patients for topics to be covered during an upcoming appointment. From there, patients who so choose can follow-up with the provider with their own questions. This appointment agenda-setting has shown to improve patient satisfaction and clinic efficiency.
While those functions are exciting for Elhaj, the true beauty of their outreach tool lay in its simplicity. These messages relay need-to-know information, keeping patients and office administrators from getting stuck on an off-topic phone call.
Too often, a reminder phone call will result in numerous patient questions that can and will be covered during an appointment. But prior to an appointment, Elhaj and his team are primarily concerned with confirming patient attendance and other key materials such as insurance cards and health records from a primary care provider.
“What we found with the test messaging is the rates of them seeing it and responding to it are much, much higher,” he noted. “It doesn’t work for everything, but we find that for direction questions, direct information where there is not a lot that has to go back and forth, for things like insurance cards.”
Elhaj and his team don’t use text messages for all patient outreach, he added. If a provider needs to follow-up about how a patient is feeling or if the patient has a question about her health, the patient portal or a phone call is still best. This preserves the human element to healthcare.
“This is not the point of the patient portal,” Elhaj asserted. “Patients call with clinical issues and they talk to either us or they talk to a nurse and they relay the message to us. The idea is this is an extension of trying to find a way to communicate 80 or 90 percent of the information that goes back and forth from patient to doctors’ offices such as appointment confirmation and billing reminders.”
While the healthcare industry continues to emphasize the need for human-centered healthcare, the fact of the matter is automated patient outreach improves patient satisfaction because it makes the smaller parts of healthcare easier for patients.
“Nothing replaces a voice on the phone or a person face to face,” Elhaj concluded. “However, most people prefer it to be as quick and easy and painless as possible. If they have specific questions about clinical issues, we have staff that answer phones and we have voicemail. But this takes care of reminders.”