Now that I am a “civilian,” I get to experience the health care system like most of you. I marvel at the degree to which customer service mechanisms used by service providers in other sectors do not exist in health care. Please understand that I am not talking about the quality of care, or empathy, or attentiveness offered by doctors, nurses, radiology techs, lab techs and the like. On that front, I remain tremendously impressed. Indeed, I am even more impressed that they can offer such fine care now that I get to witness the logistical “systems” in place to do the humdrum things that are required to provide service, work flows whose design not only makes things harder for patients but also for providers.
For example, I contact my PCP who recommends that I see a specialist. The PCP is on the patient information portal, but the specialist is not. This means that I cannot use the portal to set up an appointment. Can I do it by email? No, I am told. I must call the specialist’s office. This results in several back and forth telephone calls, using up the precious time of both the patient and the desk clerk. An opportunity to benefit from the asynchronous nature of email or other electronic scheduling is lost.
I need to have an image made before seeing the specialist. His office tries to enter the order for the image, but the system kicks it out because my insurance company does not have the name of my PCP in its records. The person entering the order does not have the authority or ability to inform the insurance company of this piece of data, although it is known to her. Instead, the specialist’s office has to contact me, and then I have to contact the insurance company, and then I have to call the office back and tell them that I have done so, and then the order can be entered.
Then, because electronic scheduling does not exist, I have to call the radiology department to get an appointment for the scan. Here’s the first bit of good news. The scan and the radiologist’s reading is inserted into my electronic medical record so the specialist has access to it before my appointment. Indeed, I have access to the report, too, through the patient portal (oddly, in that the specialist does not participate in the patient portal.)
But my PCP and the specialist recommend that I see yet another specialist. I search for his information and find that he uses the patient portal. I go to my page in the patient portal and attempt to add him as one of my doctors so I can make an appointment electronically, but the following message appears saying that I must have an initial appointment with him before I can do so: Catch-22!
There is no email available for him, so I am left to call his clinic and make an appointment.
By the way, this occurs in a physician practice organization that regularly receives awards for being part of one of the most wired health care institutions in the country. And, truly, it deserves that honor compared to many others, but the kind of lacunae I describe above are indicative that the standard against which such awards are granted is low compared to what you would expect in many other industries.
Also, the Press Ganey survey I received after the appointment with the first specialist had no questions related to any of these problems.
Paul Levy is the former president and CEO, Beth Israel Deaconess Medical Center and blogs at Not Running a Hospital. He is the author of Goal Play!: Leadership Lessons from the Soccer Field and How a Blog Held Off the Most Powerful Union in America.