The Business Case For Patient and Doctor Experience Innovation

There are three basic ways to establish or TEE up a competitive advantage: Technological excellence, Execution/operational excellence and customer Experience excellence e.g speed, convenience, service and high touch. You must dominate on one, but be equally competitive on the others. Here is how to measure them.

While policy makers are pushing value based care, convenience care is more important to patients. In addition, the poor doctor experience is causing burnout and career dissatisfaction. Sick care delivery is presently organized for the convenience of the doctor, not the patient. Changing that model by "democratizing" care or consumerizing it causes workflow disruption and resistance.

Consequently, many sick care entrepreneurs are trying to improve the doctor and patient experience. Several companies are using AI and machine learning to do so using apps and mobile platforms, voice to text technologies and products designed to work around the lack of EMR interoperability. However, whether successful improvements in patient and doctor experience translates into higher value, i.e. quality per unit cost or significant reductions in waste and unnecessary patient visits, is difficult to measure.

Examples include doc-on-demand (Healthtap), patient reported outcomes (Cliexa), distributed care coordination documentation (mCHarts), a digital assistant for doctors (Suki) and symptom checkers (WebMD).

Hospitals with high patient experience scores performed better on a number of clinical quality measures, further evidence that such efforts provide a clinical return on investment. Demonstrate a correlation does not mean causation, though. 

Researchers at Deloitte compared patient experience scores from Hospital Compare to quality measures that looked at both the point of care and outcomes, including emergency department wait times, readmission and mortality rates and hospital acquired infection rates.

They found that hospitals with “excellent” ratings (a 9 or 10 out of 10) for patient experience performed better on many of the 18 included clinical quality measures when compared to those with “low” (a zero to 6 out of 10) scores for experience.

However, several studies have failed to correlate patient satisfaction scores with quality scores.

The challenge, then, is to translate data to experience to measurable value. Here are some of the problems and challenges with data, data everywhere. Here are some solutions.

In order to reduce spending, the Institute of Medicine suggested attaching incentive payments to high patient satisfaction scores, ideally driving providers to deliver high quality healthcare. The Affordable Care Act also established a provision for value-based purchasing, which created a set of quality measures that included patient satisfaction scores.

But those scores have been ineffective in actually improving quality healthcare, these authors said, influencing the way physicians deliver treatment potentially for the worse. In an attempt to avoid penalizations for low patient satisfaction scores, many physicians alter their practice in ways that don’t improve patient wellness and outcomes.

Doctors are increasingly being disintermediated in every phase of care, including DIY initial diagnosis, clinical decision support and computer vision assisted diagnosis, treatment, and post treatment follow up and chronic disease management.

AIntrepreneurs should keep their I's on the prize and demonstrate D2E2V (data to experience to value). The Apple Watch detecting atrial fibrillation is already getting push back from cardiologists overwhelmed by messages in their inbox. Thirty teams are advancing in IBM Watson’s international AI competition, with healthcare startups making up more than half of the top 10 finalists.

Digitizing the patient and doctor experience and translating it into value requires changing your business model, not your technology. In sick care, that will require changing some rules since rules drive ecosystems that create business models that drive or inhibit innovation.Primary care physicians, for example, do not routinely put patient-reported symptoms regarding sleep, pain, anxiety, depression and low energy or fatigue into electronic health record systems. At the same time simply putting patient symptoms—which often go unrecognized and undertreated by busy clinicians—into the EHR won’t address the problem by itself. The key is making the information actionable in the context of a primary care physician visit.

The point of improving the doctor and patient experience is not to make them feel better while they continue to waste money and resources.

Anything short of delivering multiples of value that does not disrupt workflow or improves workflow is technoinnovation hype and theater that misses the mark, and, quite conceivably, adds cost and workflow disruption that makes the doctor and patient experience worse, not better and has little, if any, favorable impact on quality or cost.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs.