The gravitational force in a black hole is so high that light is not transmitted to the external world – that’s why its called a black hole.
What do you do when your patients fall into a black hole?
When a patient leaves the office, information regarding patient issues and compliance with treatment plan are usually trapped in the black hole of the patients personal experience until the next office visit.
Any healthcare provider; primary care doctor, specialist or HMO needs to sustain and improve operational efficiency (doing more with less resources), retain profitable customers and provide a high level of clinical care. From an operational perspective, healthcare is no different from any other business.
From a medical perspective – medical care is not a commodity.
For the primary care physician, the challenges become more complex since he or she needs to be able to recognize the faces in the high speed train running through his office and successfully pick the serious, life threatening issues from the flu and runny noses.
For specialists such as neurologists, who treat patients with slow-developing long-running diseases like Parkinson, there are additional requirements to monitor the patient over long periods of time and maintain an effective doctor-patient relationship that enables acquisition and analysis of accurate data regarding changing symptoms.
Whatever the use case of medical care– whether primary care or specialties; once the patient leaves the office, he enters that black hole of information deprivation, where the doctor doesn’t know what is happening. This is black hole of intangibles, of subjective perception, fears, post-hoc error, lack of understanding and non-compliance.
This is a familiar and fundamental problem of customer service. There are 3 kinds of customer service in my experience:
Great customer service
In Type I customer service, the vendor/service provider drives the problem-solving process in a proactive fashion. Problems are often solved with a single phone call, email or visit to a search engine. The customer closes the issue, not the vendor.
This is great customer service since the customer is guided by the hand and doesn’t fall into a black hole.
Doctors may or may not be able to do this, since there are often many external factors that are not under the doctors control starting with the the uncertainty of the diagnosis. Let’s face it: people are not a smart phone that can be fixed or replaced.
Bad customer service
In Type II customer service, the customer drives the problem-solving process. Solutions to the customer issue are rarely an atomic transaction that starts and finishes in a single call. Self-service is never an option. Faxes, escalation and approval loops are the norm. Frustrated, and dragged around by the nose by a customer service bureaucracy; the customer at first waits for answers, then searches for answers and consults with friends and family. The customer is in a black hole and if the issue and emotional level become serious enough, the customer leaves the vendor/service provider. This is bad customer service.
Doctors should definitely not be doing this.
The ultimate customer service: not needing service
For consumer products – there is a third kind of customer service; Type III. In Type III customer service, the vendor gets it right the first time. The product makes the customer ecstatic and never needs to be brought into the shop.
As long as people get sick, doctors will never be able to do this. Unfortunately, medical care is not a consumer products, because human beings are not electronics systems and they have personal, family and social context in addition to the complexity of whatever clinical issue the doctor needs to address and people easily fall into black holes with their physician.
How do you keep your patients from falling into a black hole?
One option is telephone follow-ups; most doctors have neither the bandwidth, nor the manpower to do this.
Another option is to have patients use a PHR (personal health record) application and use the PHR to provide feedback to the doctor in-between office visits.
Why PHRs cannot light up the patient trapped in a black hole
A PHR might seem to be a good solution to lighting up the patient in a black hole but PHRs have numerous problems that make them a poor fit for lighting up black holes:
Security – A cloud based PHR is vulnerable to the usual Web-application / mobile security threats. Murphy’s Law virtually assures us that precisely when the doctor needs some critical information, the PHR won’t be available.
Privacy – Once we need to manage granting of access rights from a PHR to physicians’ EHR systems, we start getting into all kinds of information and software application integration complexity. Granting permission to your primary care physician is fine, but what about the specialist that she consults with; how do we ensure privacy when many people are involved. With the integration of PHRs and social networks, it is now possible to mount a side-channel attack and identify a person from their aggregated data even if it was de-identified.
Information quality – Patients are information junkies. The information they record in their PHR may simply be irrelevant to their particular clinical issue. Having the ability to record lots of information in a PHR may actually increase anxiety and drive the patient deeper into her black hole creating a potentially dangerous situation.
Social and education levels – Are patients capable of taking a mobile PHR app, installing it on a cheap Android tablet and understanding how to use it properly? Probably not.
Lighting up the patient in a black hole with private messaging
By providing a secure and private messaging channel between the physician and patient we can solve the black hole problem by building upon the respective roles of physicians and patients: A physician is an expert in clinical diagnosis and treatment and is scientifically trained, a patient is the expert on his personal experience.
A no software solution for tracking and ensuring patient compliance
Instead of maintaining a PHR database, an EHR database and trying to glue the two together, we can use private messaging for tracking and ensuring compliance and do it without installing any software at the doctor premises or at the patient home.
Email is a poor fit for patient compliance follow-ups because of the data volume, the distractions and the advertising and the way it encourages the need for instant gratification with a reply.
How does it work?
- Doctor diagnoses the patient, provides a plan of treatment and sends the patient home.
- Doctor establishes a digital follow-up cycle – for example 2 days, 7 days, 1 month or 3 months after the office visit.
- Doctors respond to patients using the digital follow-up cycle. This enables the doctor to manage his time and avoid unplanned interruptions from patient email. If something urgent happens – the patient or caregiver can always call the office.
- Send a “ping” message to the patient inside the digital follow-up cycle. Patient replies to the message with his personal experience. This enables to patient to be guided clinically by the physician and helps ensure information quality – one of the big issues with PHR applications. In order to save time the ping message can be automated.
- Doctors read the message at the end of the follow-up cycle and respond. This reduces doctor stress, enables the doctor to manage his time and tames the information junkies not to expect instant gratification from their physicians.