The patient view of his medical record. User Experience Fail.

Primary Care Problems – Will Disruption Occur Faster Than These Can be Fixed?

February 19th, 2016

A Consumable Science executive, Tom Santi, indulges us with documentation of his recent user experience in scheduling and completing an annual physical and lab appointment. It glaringly demonstrates some of the issues with patient touch points in a legacy healthcare system. The provider/health plan names have been withheld to protect the guilty. Enjoy this tongue-in-cheek dispatch while you re-imagine healthcare.

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I went to schedule my annual physical with the same doctor that I went to last year, trying to develop that ubiquitous, and, as the profession claims, “important doctor-patient relationship”.  In late November, I called to make an appointment for mid-January. Again, desiring to be that well-educated, cost conscious and judicious user of health care, I thought I’d verify that the doctor was still in the network. I have an individual market policy purchased directly from a large insurer.

Where Are Thou, Oh Network?
That’s when the fun began. I couldn’t find my doctor or my lab on the insurer’s Find a Doctor website. From working within the healthcare industry, I understand that out-of-network providers = ridiculous rack rate charges. Therefore, I called my doctor’s office and they confirmed that they were in the network for both 2015 and 2016. So, yet again, wanting to be that well-educated, cost conscious and judicious user of health care, I called the insurer to verify in-network status since the website was giving me different information than my doctor. After spending over two hours talking to three different customer service agents, one of them finally went to another system the insurer has to verify the lab and doctor were in the network. I was told that, yes, both the lab and the doctor were in the network.

My favorite part of the two+ hour ordeal was when one of the reps told me that the insurer has no control over which doctors or labs are in the network and that it’s up to you (as the consumer) to call the lab and doctors to determine if they will be signing the network contract. I proceeded to fire off a not-so-nice note to one of the EVPs explaining my frustration. Why do you want your customers spending two hours on the phone with your reps at a cost for something that should have taken less than three minutes to perform on the web? I also included some brilliant, obvious suggestions for how they could improve the customer experience. To her credit, the executive responded to my e-mail over the Thanksgiving weekend and had two other people call me. They took my feedback seriously and purportedly improved the experience. I should have billed them – I probably saved them hundreds of hours of customer service agent time!

On to the Lab, Where I Bask in True Dedication to the Customer Experience
The lab had a cool “schedule your appointment online” tool that worked great. All set for 10:00am on Monday. Yet again, wanting to be that well-educated and efficient user of health care, I call my doctor’s office to verify that the lab has the order and I’m good to go. All confirmed – the doctor’s office entered all the information electronically into the lab order system.

I show up at the lab facility at 9:58am to check in. By merely showing up and standing at the check-in window, I’m clearly annoying the receptionist. In a rude manner, she tells me that I have to give her my order form. I tell her that my doctor’s administrator entered it in their electronic order system. That seems to bother her even more than my physical presence there.   She finally gets me checked in and I take my seat in the lobby. The place feels more like a doctor’s office than a doctor’s office does.

Twenty minutes later I am called in. I was told to drink a lot water as they would be doing a urine test. So by this point, I’m really needing to give that sample. I ask the phlebotomist if they need a urine sample. She replied, “I have no idea what you are here for.” I’m now even more impressed with their customer service model – at least they are consistent in providing a horrible experience. She checks the computer and hands me a plastic cup and alcohol pad. Her only instructions are, “bring it back when you are done.” I’m still not sure of the purpose of the alcohol pad.

I return and sit in the chair. The phlebotomist inserts a needle to my right arm. I’ve donated a lot of blood in the past and am fine around blood and needles, but this is really starting to hurt. She then proceeds to say, “I must have missed the vein because no blood is coming out.” She removes the needle and replaces it with a new needle and inserts it in my left arm which hurts more than I’ve experienced before, but at least the blood is flowing. Moments later, I hear a scream from someone in the next room. Apparently that phlebotomist didn’t apply the rubber-band-tourniquet on the patient correctly. It flew off and hit the patient in the face. Five vials of blood later and I’m happy to be out of there relatively uninjured.

Fortunately, the Physical Exceeded My Expectations
I was always a little dubious of the value of an annual physical, but was very impressed with this one. The reminder notice I received for the appointment mentioned the practice had recently converted to a new EMR system and things could be a little delayed as they all adapted. I appreciated them setting that expectation up front. My wait time was minimal. The nurse was very friendly. The doctor was very patient and wasn’t rushed at all. I felt like I was an important patient. She made sure I got all my questions answered and did a great job explaining things in non-medical terms. She reviewed all of my lab results. And she explained what she was going to do before doing it, something I always appreciate.  She even gave me the choice of having all my lab results printed there or accessing it online.

The only piece I still don’t understand is, with the advent of Electronic Medical Records (EMRs) and how familiar most people are with computers, why do doctor’s office administrators still hand you the clip boards with the sheets of paper to fill out your medical history? Let me do it ahead of time from my smart phone or computer or at least have a kiosk in the office where I can enter it all and it gets posted directly to my EMR.

Someone Forgot the Patient is Going to be Looking at the EMR Online
I was excited that the practice was giving me access to my records electronically. Nice feature. Unfortunately, their EMR vendor would appear to have given zero thought to the patient user experience in reviewing the records. It would be helpful if you could click or hover and the EMR system would give you more information about the molecule tested. Looking at this screen doesn’t really entice the user to explore deeper.

But it’s at least a start to provide more information to the patient and hopefully create greater patient interest and engagement in their health. I applaud that.  It will be interesting to see the continued evolution of healthcare as consumers demand more value, better experiences and greater access to their medical records and history.