Lisa Eramo, MA, is a contributing author for Medical Economics.
Physicians enter the medical profession because they want to take care of patients, not focus on administrative tasks. Yet these tasks continue to dominate their time and attention, leading to frustration and burnout. Administrative tasks also overwhelm staff, fueling job dissatisfaction and turnover.
“If you find yourself saying, ‘There’s got to be a better way,’ then it’s time to take action,” says Rob Wiley, head of marketing and product strategy at Formstack, a workflow and process automation vendor in Fishers, Indiana.
The COVID-19 pandemic has made it increasingly necessary for practices to shift certain time-consuming administrative tasks from a manual to a digital workflow, and to use digital methods for services that have been done in person in the past.
Beyond COVID-19, this shift can also help practices meet patient demands in an era of health care consumerism, says Michael Morgan, CEO of Updox, a customer relationship management vendor in Dublin, Ohio. “Patients expect to be treated like customers,” he says. “You can’t use old processes — phone calls, paper and voicemail.”
Consider digitizing these three tasks:
Having patients check themselves in can boost staff efficiency while simultaneously decreasing patient wait times, says Craig Cooper, product manager at AdvancedMD, a cloud-based software provider in South Jordan, Utah. Using practice-owned tablets or kiosks that connect directly to a secure check-in app, patients validate demographic and insurance information and more, all without interacting with front office staff.
When using the check-in app, patients also can review outstanding balances and pay the amount owed, reducing the time staff members spend following up with unpaid invoices, Cooper says.
In December 2017, Thomas Miller, M.D., a family physician in Arlington, Texas, started having patients use a self check-in process. “I have experienced a significant return on investment,” Miller says. “It streamlines check-in and frees my staff for other tasks.”
Anything physicians can do to use less paper is beneficial, Wiley says. Paper forms have many drawbacks: Patients aren’t usually able to complete them in advance and don’t arrive early enough to complete them prior to their appointment; patient handwriting may be illegible; and front office staff must spend time scanning the forms into the electronic health records system (EHR).
“Using mobile-friendly forms allows patients to provide their information from any device at any time before their appointment, which increases efficiency for patients and providers alike,” Wiley says. These HIPAA-compliant forms can then be automatically uploaded to the patient’s record, giving providers immediate access to the information that’s critical for accurate diagnosis and successful treatment.
Tips for success
Make self check-in a personal experience. Ensure that a staff member is always available to greet patients upon their arrival, direct them to the tablet or kiosk, and assist them if questions arise, Cooper says.
Choose a user-friendly application. Look for apps that provide simple navigation with clear instructions on how to proceed from one step to another, Cooper says.
Prepare for faster check-ins. If your practice has more than one tablet or kiosk, multiple patients can check in at the same time, thus increasing patient flow on the front end. Practices may need to consider hiring additional medical assistants or providers, positions that are often funded by reducing front-end full-time staff, Cooper says.
Encourage patients to complete forms in advance so they can focus on providing accurate and complete responses without distraction, Wiley says.
Long gone are the days when patients were willing to wait on hold or play phone tag to schedule an appointment, hear about a lab result or request a prescription refill. In addition to communicating with patients via a secure portal, another method has quickly emerged as the new normal: texting.
“Physicians need to accept that texting is here to stay and that it is the preferred method of communication by every generation,” says Kathy Ford, president and chief product officer at Rhinogram, a telehealth communications company in Chattanooga, Tennessee.
Texting not only improves patient satisfaction, it also reduces the administrative burden on physicians and staff. “Physicians love not being tethered to a desk in order to respond to patients,” Ford says. Staff members can text multiple patients almost simultaneously while seeing a 50% reduction in phone calls, according to Rhinogram data. The best part? Staff training is minimal, and staff are often able to respond to messages within 10 minutes. Contrast this with voicemails. It typically takes staff at least 24 hours or more to respond to voice messages, she says.
Practices also may be able to use HIPAA-compliant texting to facilitate and bill for chronic care management. Other potential services include asynchronous remote evaluations, virtual check-ins, and online digital evaluation and management services, depending on the payer, says Ford. These types of visits can be particularly helpful during the current COVID-19 outbreak because they eliminate the need for patients to come into the office, she adds.
When coordinating care with other providers, practices spend a considerable amount of time sending and receiving paper faxes — a task that can be digitized to improve efficiency, says Morgan. Online faxes are automatically downloaded into a HIPAA-compliant platform where they can be routed to the appropriate individuals (e.g., a medical assistant who receives all faxes related to durable medical equipment and then contacts patients regarding insurance coverage). Staff also can send faxes with a click of a mouse.
“Before we went digital, we had to schedule one staff member, usually a medical assistant, away from their normal duties so they could concentrate on faxes,” says Stan Adamek, D.O., co-owner and physician at Bridgeport Family Medicine in Tigard, Oregon. “We were at the point of deciding to hire another employee just to help with all of the faxes, medical records and pharmacy requests.”
The return on investment has been significant, Adamek says. “Our staff can work more efficiently, and we are saving money from not having to buy pallets of printer paper,” he says. “We’ve also reduced the cost of shredding services, not to mention being able to reduce our impact on the environment.”
Tips for success:
Educate patients. Alert patients waiting on hold on the phone that they can text the practice instead, Ford says. Put up signs in the waiting area informing patients of the option to participate in secure texting. Also provide this information on the practice’s website and Facebook page, she adds.
Obtain patient consent. Per an exclusion in the Telephone Consumer Protection Act, practices don’t need to obtain patient consent for texting about appointment reminders or clinical information, but they do need it for everything else, even to wish patients happy birthday, Ford says. Still, best practice is to let patients choose what types of text messages (if any) they prefer to receive. Be sure to inform them that any information they send isn’t protected until their provider receives it. This means it isn’t protected during transmission from their phone to their carrier and from their carrier to their provider, she adds.
Use HIPAA-compliant texting. Physicians shouldn’t text directly from their private cell phone because it’s not secure, and messages ultimately reside on that phone, not in the patient’s record, Ford says.
Develop protocols for texting. For example, determine whether the practice will permit staff to text all lab results or only negative ones, Ford says. Some practices, for example, permit texting positive lab results because they can also set up an in-person appointment or coordinate a prescription during the same conversation.
Ensure HIPAA-compliant texting can automatically route text messages to the appropriate individuals, Ford says. Being able to route messages to specific physicians during a specific timeframe (e.g., 48 hours post-surgery, when complications could develop) is also beneficial, she adds.
Physician documentation is one of the biggest administrative burdens, requiring 16 minutes on average per patient encounter, according to a recent study published in the New England Journal of Medicine Journal Watch. Yet this documentation drives care coordination, medical coding, reimbursement, quality metrics and more. Speech recognition software (which costs an average of $1,200 per physician annually) can help reduce documentation time by as much as two hours a day for most physicians, says Peter Durlach, senior vice president of health care strategy and new business development at Nuance Communications, a health care software company in Burlington, Massachusetts. It can also generate higher reimbursement. “Physicians using speech recognition tend to describe more of what’s going on with the patient,” he says. “This means they capture patient acuity more accurately to drive more accurate payment.”
Tips for success:
Weigh all options. Some physicians may prefer to hire an onsite or virtual scribe to alleviate documentation burdens, while others prefer solutions that provide a more technology-centric experience, such as ambient clinical intelligence (ACI), says Durlach. With ACI, physicians and patients talk and artificial intelligence technology converts their dialogue into a clinically accurate note populated in the EHR, he says.
Be prepared to validate. Today’s speech recognition products are highly accurate, regardless of accent and specialty. However, physicians must always take a few seconds to review the text before signing off on it, Durlach says.
Consider workflow. When using speech recognition, it’s often most efficient to dictate during the patient’s appointment, Durlach says. Physicians who do this prevent documentation from backing up until the end of the day. They also benefit from patients being able to listen and make corrections, he adds.