By JOSEFINA JERVIS and MICHAEL TURPIN

As the digital economy transforms health the most transformative ideas and consumer engagement solutions can sometimes challenge the industry’s ability to adopt and implement them. Reimbursement reforms, risk sharing, migration towards high deductible plans and the expansion of public and private coverage are converging to unleash an increasingly sophisticated consumer into the marketplace. Health systems and physician practices are consolidating and marketing their services direct to consumers in an attempt to underscore the critical differentiators valued by consumers – access, quality and affordability.  In today’s consumer economy, access remains a critical criterion for choosing and patronizing a provider or a practice. To assist the move toward consumerism, employers are introducing tools to facilitate comparison-shopping for services seen as “consumer-driven.”  The cost of elective and non-emergency services are highly variable and employers want employees to become consumers making decisions based not only on access but also cost. Providers that succeed in offering affordable access to care will gain a disproportionate amount of market share of the unaffiliated insured. It all starts with patient scheduling and facilitating a better consumer experience. Providers are under siege from a range of first generation solutions’ providers promoting their ability to transform analog business practices into digital delivery.  HIT requirements and the emphasis on electronic medical records have created technology companies who are offering suites of services to manage patient data and integrated care delivery. It’s been proven that 24/7 patient scheduling will reduce “no-show” rates, improve consumer satisfaction and ensure a higher volume of patients. The most important initial healthcare encounter – the appointment scheduling process remains surprisingly analog. While other consumer industries have moved quickly to facilitate online access, consumer-based medical practices remain stymied by fixed office scheduling hours with zero patient medical record interface and limited access outside office hours. The scheduling revolution initiated a few years ago with the birth of ZocDoc, Patient Engagement 1.0, established that self-scheduling can offer an advantage to providers and patients. Additional 2.0 firms such as openDr have built on and improved capabilities into the self-scheduling space – a function that is now crowded with models that can be leased or purchased. Accenture published two studies in 2013 (“Consumer Survey on Patient Engagement” and “Why First Impressions Matter”) in which they found that 77% of patients prioritized booking, changing and canceling appointments online as important. Accenture estimated that 1 billion healthcare appointments will be self-scheduled by 2019.  The study revealed that patients prioritize convenience and transparency.  They estimate that today patients spend an average of 8.1 minutes scheduling an appointment and 63% of the times their calls are transferred.  This represents an opportunity for some providers to overcome an industry compromise that has eroded patient satisfaction with access. Practice management professionals acknowledge that relying solely on schedulers to book all appointments is not only inefficient but a detriment to any organization because it inhibits growth and acquisition of new patients.  It’s clear that no organization can afford to remain “off-line.” Over time, it is inevitable that administrative FTE reductions will occur in practices as technology and self-service supplants old models of delivery. The impediments to provider adoption of self scheduling are surprisingly basic and range from concerns over patient privacy to internal struggles within provider practices as digital transformation threatens jobs and creates conflicts of interest over whether a system or provider group should buy, build or lease a self scheduling capability. Healthcare executives need to ask themselves not whether to offer patient engagement solutions but what’s the most efficient way to get online fast.  A few things to consider:

• Should I build it? When it comes to technology, the question is always the same:  should a system or practice lease a solution that is premade and configurable, buy an existing solution and conform it for their business or build it from scratch to fit their enterprise?  While most healthcare executives acknowledge that reimbursement reforms and risk sharing will require substantial productivity gains and lower human and capital expenditure costs, many groups are still captive to the notion that building capabilities is preferred to leasing or purchasing applications.  Ironically, these practices obligate the system to continue expensive technology budgets and engage them in an arm’s race to keep pace with competitors who have leased or purchased the latest technology. The stress any organization will undergo to build, maintain and manage a solution needs to be considered.  Healthcare IT executives clearly have a bias to build.  It’s increasingly incumbent on hospital executives to challenge the notion that everything must be homegrown. 
• How can I avoid the 1.0 technology trough? – Patient Engagement 2.0 players are leading the innovation roadmap in healthcare and must be taken seriously given their level of sophistication and technological powerhouse.  Patient Engagement 1.0 players and EMRs have launched a process but may be shown over time to be less than fulfilling when it comes to critical technology elements, such as interoperability, time-to-market, customizing the solution to fit your enterprise.  In any cycle of technology adoption, there is a period of irrational exuberance, first mover adopters, disappointments, and a trough of disillusionment – always followed by new entrants, 2.0 solutions that correct for 1.0 limitations and an acceleration of adoption. 
• Should I buy from my existing HIT provider? It’s natural for a system or provider practice to seek to extend a relationship with a vendor who provides existing services.  Many technology and HIT providers are seeking to upsell the tools they provide to clients but have extended beyond their core competencies. Established EMR companies are rarely the best equipped to tackle such level of innovation because just like the healthcare systems they serve, they too have many conflicting priorities and large customer bases to manage. Small and medium size healthcare systems and EMRs should look at leasing as the most agile and efficient way to get in the online patient engagement marketplace. Large healthcare systems and EMRs should consider buying each consumer module based on the functionality and its ability to interface with core systems.  Purchasing is a more effective means to keep pace with the best capabilities of consumer-centric competitors.  

Healthcare is shaking under the tectonic plate shifts of consumerism, reimbursement reform, consolidation and the rapid rise and role of technology in facilitating access, quality and patient outcomes.  Any consumer business will reveal that everything begins with the first patient encounter.  As demographics shift and self service and digital access supplant traditional analog scheduling, those who do not go online will find themselves on the sidelines watching a shift in patient access and loyalty patterns that may leave them and their practices in intensive care.

Josefina Jervis is the CEO of

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