Technology seems inextricably linked to physician practice management these days: It can streamline billing, expedite patient registration, manage databases and much more.
The demands of managed care on physicians to see more patients in less time with less compensation requires more efficient operating strategies. By streamlining communication between doctors and patients, available tools can help physicians more effectively manage care.
In fact, physicians are bombarded by news about software that can accomplish these tasks. For those too busy or too technophobic, the temptation to crouch behind the examining table when the software rep shows up is powerful.
But a simpler option is available, one that's meant to streamline doctor-patient communication. And the good news is it's based on the use of familiar technology-- the telephone.
Telephonic systems don't have all the bells and whistles of more sophisticated, integrated software systems. But they can save time and money, according to some doctors.
Among the time-consuming tasks telephone systems can efficiently perform are reminding patients of appointments and conveying normal lab results. They also can alert patients to wellness messages and programs, such as smoking cessation, weight reduction or mammograms.
Andrew Svetly, M.D., medical director of clinical informatics for Scottsdale (Ariz.) Healthcare, an integrated delivery network, says his automated telephone system benefits his patients and his bottom line.
"It cuts down on nursing time (spent attempting) to reach a patient," he says. "Patients can access the information at any time, nights or weekends, and don't have to play phone tag. In a study, we found that it takes up to 10 minutes to complete a nursing call--between when the nurse returns their call and them missing each other. We've taken out all the byproducts of that process and just skip to delivering the message. The average test result message is about 45 seconds. Compare that to 10 minutes, and you have an obvious savings."
Svetly uses Atlanta-based McKesson-HBOC's Patient Test Results.
Like other automated systems on the market, the system is not intended to eliminate the personal interaction essential to a patient-provider relationship.
For example, unexpected or abnormal lab results are never delivered on the system; they are always handled personally.
At Svetly's organization, a nurse reviews all test results every day.
"Unexpected abnormals are difficult (to deliver), and we don't use the system to deliver them," he says.
Ed Reichstein, vice president of product marketing for SmartTalk.com based in Boulder, Colo., which makes a similar system, says the goal is for physicians to interact with patients on a more regular basis while still managing time effectively.
"Think of this as sort of a central hub where lots of different information is being provided to SmartTalk," he says.
Other similar systems include Parwan Electronics Corp.'s Reminder 2.0 and JulySoft's ReminderPro.
The systems deliver information to the patient, allowing them to respond with a series of instructions, similar the process of checking balances in bank or credit card accounts.
The systems then incorporate the patient responses into usable data for the physician.
Exchanges can be as simple as reminding patients of upcoming tests or physicals or as detailed as compiling patient satisfaction surveys and instantly tabulating results.
"For example," says Reichstein, "(the system) can inform the female population over 40 to come in for mammography, remind them of that, then find out how many come in and how satisfied they are."
Timothy McCurry, M.D., director of Resurrection Health Care's family practice residency program in Chicago, uses SmartTalk. "As soon as we get the test results, we sign on and (record) a personalized message to the patient. That way they hear our voice," which might be a contributing factor to the positive response he has received from his patients, McCurry says.
"They get the results at their own convenience; they don't have to play phone tag. We had concerns originally about how the seniors would deal with it, but they love it. They can listen to it a couple times if they want to or have other people, such as their children or spouses listen to it."
In Resurrection's case, McCurry notes, the system right now is primarily an added perk but eventually it could be a boon to productivity. "If we had a higher volume of patients, it could potentially save lots of time. But we have 22 part-time physicians. Our volume is not as great as a bigger firm, so the savings aren't as great," he says. Resurrection is exclusively using the system's lab results service.
SmartTalk's pricing is negotiated on a case-by-case basis. In the case of a 20-physician practice, the company would charge a $1000 to $3000 setup fee, based on the clinic's size. After setup, fees are transaction-based.
Typically, appointment reminders cost about 25 cents per call and lab results are about 70 cents each. Other types of communication, such as surveys and health messages are available, with varying pricing structures.
Such systems, Reichstein says, take a minimal time investment on the part of physicians--deciding what messages to send out and recording them only once.
The physician or nurse can either record a custom message detailing test results or direct the patient to a previously recorded standard message. For example, a standard message for an OB/GYN practice might say, "Your pap test was OK, please come back in one year."
Once that process is finished, the system runs by itself so physicians have more time without interruptions, which means they can see more patients, which brings in more revenues, Reichstein says.
Svetly says that with Patient Test Results, less nursing staff time is spent on the phone. While his practice used to get 400 to 500 phone calls through the front desk each day, now those calls are lessened through automation.
"When my nurse is not busy taking calls, she's available to assist me. That is, for me, about 15 calls a day for which we use Patient Test Results, and in return I get two more hours a day, on average, of nursing time. More importantly, she's available to me and my patients all the time. There are a couple of docs here that utilize 1.5 nurses, and I'm able to function with one."
A designated system operator enters lab results once or twice a day, and that is the extent of their test-result duties.
Patients call in for test results and enter a personal identification code and their physician's code. They are told how many messages they have, then hear each message and when it was recorded.
Svetly estimates a 96% to 97% patient satisfaction rate, based on patient feedback.
"We've got six physicians in the practice and others use it differently, but I relay the messages myself. So, it's my voice (that patients hear). And when I (personally) deliver the message, it cuts down on repeat phone calls."
Patient Test Results primarily has been selling to larger physician groups and health systems but is branching into smaller groups. According to McKesson-HBOC, about 50 groups have purchased Patient Test Results. Like the SmartTalk system, it is sold as a complete package, including all the hardware and software. The cost is primarily based on how many physicians use the system.
Svetly cautions, however, that physicians using the system should establish a way to make sure patients pick up the results.
"We leave a message and give them a week to retrieve the message. There's no immediate confirmation," he says.
The system has detailed reporting functions, but they occur after the fact. Says Svetly: "We review the reports weekly and then have a list of unretrieved messages. The nurse then has to call those patients to ask them to pick up the message. We then wait to check the next report to see if they have."
In contrast, the SmartTalk system allows the physician or staff to automatically receive confirmation that the patient got the message.
In a few instances where patients had a problem accessing the information, Svetly says it was because he entered their security code incorrectly.
"That was my error, not theirs and not the system's," he says.
An added benefit to the patient is an increased monitoring of their ongoing healthcare routines and maintenance. According to Regina Herzlinger, author of Market-Driven Health Care, the transition to electronic reminders from paper can have a significant impact on patient compliance. In the book she writes, "computer-generated calls that remind parents of appointments for immunizations have increased the kept appointments by 183%." That means vacant schedule time resulting from unkept appointments is reduced, which also significantly affects revenues.
And electronic systems might have far-reaching public health results as well.
According to a 1997 study by the American Journal of Preventive Medicine, a telephone call was more effective than a letter or postcard in increasing participation in wellness and prevention programs. Women who received a telephone call, rather than a personalized letter or birthday card reminder, were most likely to obtain a mammogram: 28% of women in the telephone group went in for a mammogram, compared with 15% in the card reminder group and 9% who received a letter.
Alison J. Miller is a former Modern Physician copy editor.