Monday, August 13, 2012

Please remain on the line

The patient entered her kitchen with the phone on speaker.

"I've been on hold for 10 minutes," she told me as she made a cup of tea and settled into a chair.

"Please remain on the line," said the robot on the phone. We would hear that phrase interrupt the music-on-hold for the next five minutes.

At one juncture the patient was asked if she would like to leave a message. "Do you think they'll call back?" she asked. I shook my head, "no."

On this Monday morning the patient was trying to be engaged in her wellness. She called the local academic medical center to schedule a screening colonoscopy, an exam that has been demonstrated to save the taxpayers and her private insurer a lot of money.

Finally: "Hello, how can I help you?" The patient explained to the med center representative that her primary care physician has recommended the procedure and she would like to schedule it.

"Do you have a referral document?" asked the rep.
"What? No, I just saw her and -"
"What is your name and date of birth?"

The patient explained that she had been previously seen at the exact location she was calling. She relayed date of birth to the rep.

"Please hold while I check your record."

Another five minutes passed.

"Ma'am, I'm sorry. I found your record but I don't see a referral document."
"No, I told you I don't have one yet. If I can just make the appointment -"
"It is not our policy to make an appointment without a referral document."

The patient tried a different tactic. "I just turned 50. This is supposed to be a covered exam under health care reform. I have a PPO (health insurance plan). Why can't I just schedule it?"

The patient did not raise her voice, but she did ask very clear questions. The representative did not raise her voice but she did not offer any solutions.

Finally -- after 20 minutes of time on the phone -- the patient requested a direct phone line where she could reach this representative. It was provided.

The patient was also provided a fax number (you read that correctly) to use when sending the mandatory referral document.

Nobody except maybe Katie Couric and Mehmet Oz want to have a colonoscopy. But the evidence is clear: it saves lives and money.

So why can't we get this right?

The inefficiencies of this interaction are crazy - why doesn't the robot script START with explaining the patient must have a "referral document?"

Other problems illustrated by this example include:
  • a barrier to patient engagement
  • a lack of concern for patient satisfaction
  • the inability of a certified "meaningful user" of an EMR  to use its EMR

Fortunately for the patient, she can afford to choose a very attentive doctor with an extremely efficient staff for her primary care. The cost of this service, of course, is only very marginally covered by her employer-provided health insurance.

Office staff agreed to fax a referral and notify patient by email when the task was complete so that patient can get her necessary exam. Assuming the med center has availability...

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