In the past decade, with the near universal adoption of the EHR, healthcare in this country has made strides towards "going digital” in terms of the storage and tracking of patient data. Yet from a patient’s perspective, in 2018 the delivery of the healthcare experience continues to be seriously out of step with consumer expectations, at least as compared with other common services we engage with. If you are a healthcare provider, payer, or solutions vendor, you need to be thinking hard about how to deliver your service to the delight of your ultimate customer - the patient.
The Modern Patient-Consumer: Apps, Devices, UX/CX…and PX
As modern consumers, we carry smartphone loaded with apps that offer services and utility that cater to our every need. We’ve also in the past year opened our homes to a new breed of voice-enabled devices like the Amazon Echo, allowing us to request services and products anytime and anywhere, from the couch, while we are cooking, no need to even pick up your phone.
The best of those apps and devices are built with a keen focus on something called the User Experience (UX), which is carefully thought through so as to give the user a highly rewarding user interaction. Yet most apps and Echo skills are not self-contained systems - they represent an “endpoint", a delivery mechanism for a vendor to interact with and delight its customers. These endpoints shift the vendor-customer touchpoint away from brick-and-mortar, away from websites, and into the customer’s daily lives, through the home and pocket. The collection of these user-driven touchpoints is commonly referred to as the Customer Experience (CX). Just as with apps and UX, the best companies obsess about their “CX", and it’s pretty easy to point to companies that have “good CX” - or bad.
I believe we now need to apply CX principles to healthcare, and embrace the idea of Patient Experience (“PX”) as “a thing”. I’m not claiming to have coined the term, but given the opportunity I might define PX as "the set of interactions that a patient has with a doctor, practice, hospital, insurer, or the healthcare delivery system / solution”.
What I like about the idea of PX, is that it gives a name to something that can be focused on, obsessed about, just like UX. It also reinforces that the patient is the customer, and thus the purveyors of healthcare should be obsessing about how good their PX is, just like a good software apps company obsesses about their UX. Finally I like that PX implies some objective standard by which purveyors of healthcare can be measured, and thus strive to compete with each other on, putting pressure on other providers and payers and vendors to raise their game in an effort to delight their customers.
The Patient Experience in 2018
Today’s Patient Experience generally requires me to step out of my own world and into a world controlled by doctors and insurers, with very limited access to my own information. Lets look at a simple scenario:
I am not feeling well, perhaps I am feeling rundown and flu-like.
I call to make an appointment that fits into my doctor’s schedule (not mine).
I jump in my car and drive to my doctor’s office, endure the germ-filled waiting room, get brought into a treatment room by a nurse, wait some more
I finally get to see my doctor for about 13 minutes (according to WebMD), during which he looks at my information on his computer, and makes some notes - information about me but which I do not see during this encounter. Then he has to move on to the next patient.
I get handed a blue slip of paper with a prescription that I cant read, I take it to my local pharmacy, wait some more, and get a little container of pills with a long printed information sheet about drug interactions and warnings.
Back at home, my only view into today’s encounter is my patient portal, typically a web page where I securely login and get to see some basic information in what appears to be a website designed back in the 20th century. When I log in, the information there is sparse, rows of records, pure dry data, all in medical language. ( If my provider’s E.H.R. system offers a mobile app (like Epic’s MyChart), I can view this same information on my phone, but the data remains basic and limited. )
But wait - if I have a more serious acute or chronic health issue, requiring a visit to the emergency room or even a stay at a hospital, my sense of loss control over my own health is even greater, even in a situation where my fears and worries about my health are greater. Here
I’m whisked from room to room, according to a sequence that is completely unknown to me, a parade of doctors and nurses visit me and ask me questions, write notes on their clipboard, and leave.
Eventually I am discharged, after a long wait, never knowing when I will be able to leave.
I’m handed a couple pieces of paper stapled together, which represents what I should and should not do over the next few days, and told to make a followup appointment. In the interim I’m on my own.
At some point many weeks or months later, I go out to my mailbox and find a paper summary of how my insurance paid for my healthcare incident, described in insurance-speak.
This description sounds horrible - but familiar to most of us. Mind you, I’m not commenting here on the quality of medical care or the skills of clinicians. Doctors and nurses and care teams work really hard to fix us when we are broken and cure us of all manner of diseases. I have endless admiration for the people who treat us and perform what surely are modern medicine miracles.
I’m commenting here on the total experience of a patient navigating through the healthcare system. It shares parallels with some of the worst consumer experiences that we endure today. Air travel. Going to the local Division of Motor Vehicles. Most of us would agree that these represent the nadir of “CX”. The hallmarks of these experiences are a) loss of control b) no access to information c) you are like a fish out of water, a stranger in a strange land.
It doesn’t have to be this way.
The Amazonification of the Consumer Experience
What if this experience was held up to the kind of standards we hold Amazon, Apple, Google and Facebook to?
Think about the consumer experiences we enjoy with other services in other industries that have already gone through technological disruption. Online shopping with Amazon. Getting a ride through Uber or Lyft. Seeing a movie. Listening to music via a subscription service.
Each of these used to be like healthcare is today: the service provider was in complete control, you went to them, you had no access to information, and you waited, waited, waited. But disruption happened, by leveraging the ubiquity of the Internet and smartphones, and has brought sweeping changes and turned these consumer experiences inside out. Nowadays, shopping is done from the comfort of your home, via your computer, tablet or smartphone, and you have a wealth of choices and information to help you comparison shop. A purchase is instant with a click, and once your order is placed you have the ability to track its progress from the warehouse to your door, with alerts delivered to your phone at each point along the way. You no longer stand on the streets of New York in the cold and the rain waving your hand in hopes of a taxi seeing you and pulling over - you schedule a ride with your smartphone app, you choose the kind of car and its capacity, you decide how long you are willing to wait, you know what the drivers name and car model will be, and you get to monitor the progress of your ride the whole way. And we no longer go to record stores hoping that they will have an album you wanted to purchase, instead we call out “Alexa, play the Rolling Stones”, and our request is magically fulfilled, the music comes to us, just by asking.
What’s common about these modern consumer experiences? I would point out that the service you are paying for is delivered to you, it comes to where you are, on the device of your choosing (typically a smartphone but increasingly a voice assistant), and the time of your choosing, with transparent access to information about what is happening. One by one, many service categories of services and products are experiencing disruption, some more quickly than others, but the end result is the same - the balance of power is shifted to the consumer, you are placed in control of your experience and your data.
When Service Providers Become Obsessed with PX
What does a great Patient Experience look like? It starts by making the patient the center of the universe. Questions need to be considered, assumptions reexamined. What do patients want? What are their pain points with today’s healthcare experience? How do we give patients tools in the form of mobile apps and voice-enabled skills that let them manage and learn about their healthcare, in their homes, in their cars, on their phones, at a time of their own choosing? It means going beyond patient portals. I means going beyond basic EHR information.
Whether you are a startup or a major hospital or a tech giant, if you are planning on building a patient-facing app, it means going beyond simplistic apps that are purely informational and generic, beyond apps that are just a thinly disguised website. It means really working on your “PX” and making the patient healthcare experience be consistent with how the best vendors represent themselves with great apps and services. Now more than ever, you have an amazing opportunity to deliver great value to your patients, and in the process learn a great deal about what they like and don’t like about the service you are providing.
Healthcare is proving to be highly resistant to this kind of change, and it wont happen overnight, but it seems to me that this change is inevitable, it is not a question if, its more about when, and what parts, will undergo change. The best providers, payers and solution vendors in the healthcare space will obsess about their “PX”, and they will invest in native smartphone apps and delightful Alexa skills which shift control and access and data to the patient. They will do it because they know if they don’t, somebody else will. And because over time, the customer - the patient - will insist upon it.