How technology in the ER boosts the patient experience [PODCAST]

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“When harnessing easy-to-use technology to provide answers to frequently asked questions such as the ER wait time, or the ER’s address, for instance, patients and their families are properly informed, and clinical staff are given the time to focus on their most important job: caring for patients. The use of a secure, encrypted, and HIPAA-compliant application allows registration staff to complete their clerical work, patients can obtain the answers they need through an easy-to-use app on their phone, and triage nurses can efficiently and quickly conduct their work without interruption—it’s a win, win for all.

Technology helps patients feel connected to their health care journeys. Prioritizing patient-centric care with AI-tools enables a better experience for patients, clinicians, and care teams. Focusing on improving a patient’s journey starting from the ER creates a supported and more manageable experience for all involved, not to mention increasing patient loyalty and hospital satisfaction rates.”

Justin Schrager is an emergency physician.

He shares his story and discusses his KevinMD article, “3 ways technology in the ER boosts the patient experience.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Justin Schrager. He’s an emergency physician, and he wrote the KevinMD article “3 ways technology in the ER boosts the patient experience.” Justin, welcome to the show.

Justin Schrager: Thank you, Kevin. Appreciate you having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Justin Schrager: I’m an emergency physician. I work in Atlanta, Georgia, at Emory Healthcare. I’ve been an attending there for seven years. I have a background in data science, and I’m also the co-founder of a software company called Vital Software that does patient engagement, patient information, and experience improvement in the emergency department.

Kevin Pho: So whenever I talk to physicians on this podcast, and of course they write on my blog, I’m interested in careers and interests outside of clinical medicine. So tell me about your background in terms of founding this technology company and your motivations for doing so.

Justin Schrager: Most emergency physicians are kind of a bit of a MacGyver, and we try to fix problems with the skills that we have or the resources we have at hand. I happen to have a background in data science, and I saw a need. And I have a good co-founder in Aaron Patzer, who is a computer scientist and successful entrepreneur. So we started the company together. We happen to be brothers-in-law, and he was the founder of Mint.com back in the day, the personal finance software.

So he and I put our heads together and said, “What can we do in the emergency department to sort of bring a consumer software experience to patients? And what can we do to sort of make it easier for patients to interface with the health system, easier even than the patient portals and other things that people are used to using now?” At this point, truly bring people into the modern era of software, things that you would expect in any sort of, you know, I hate to call health care a service industry, but the fact of the matter is it is similar in many ways to what people expect. And that’s kind of what we set out to do.

We built a web app that patients use in the emergency department, and they register for care. About half the patients that come through the ERs that have the software are using it to, you know, kind of get updates on their progress through the ER: labs, imaging. And then we use advanced artificial intelligence algorithms to give them things that they want. So, “How long am I going to be in the waiting room?” Well, we have predictive models that tell them that. “How long until the CT scan’s done?” That kind of thing.

Kevin Pho: So we’ll talk about that technology a little bit in your article, but let me first ask, for those budding physician entrepreneurs who may be listening to this: As an entrepreneur yourself, what would be some actionable tips that you could share with my clinician audience?

Justin Schrager: You talk to every doctor, honestly, every doctor in the hospital has a great idea of how we can improve the software we use. I mean, frankly, the software we use in health care systems, regardless of your EHR vendor, is a bit dated, right? It doesn’t kind of match up with what you use in your everyday life: Facebook, Gmail, things like that. So there are ways to improve everything we do.

If you’re entrepreneurial or entrepreneurially minded, the most important thing you can do is to figure out the lay of the land. Figure out if what you’re talking about solving for exists, and you can partner with those companies. If you’re a physician and you don’t have engineering skills, it’s important, if you’re part of a health system or an academic health system like I am, to make sure that you avail yourself of the resources that they have. At my health system, they have an innovation center that helped us get going and partnered with us as we built up the software.

Realize that you have a distinct set of skills as a doctor that isn’t just the bedside. So you have access to the true problems. You’re talking to patients. You cross many specialties, regardless of what you do every day. And, you know, health care is a veiled system, despite it being a physical GDP, right? And as a physician, you know what’s going on. So your knowledge, just the fact that you have these ideas, is insanely valuable. So it’s not all about starting, founding companies, although that’s what I did, and I think that’s a fun thing to do. There’s also collaboration.

And then I would say the last thing you’ve got to do is you’ve got to find someone that has as much energy to start up a company with you, if that’s what you decide to do, energy to see it through. And health care takes a long time to get things going. It takes a long time to develop them. Obviously there are security concerns that other industries don’t have. The health systems are, you know, fairly slow to adapt in some cases. So you have to be patient, and in the entrepreneurial startup world, that’s not always the case. You know, I would say it’s a roller coaster. There’s lots of ups and downs, and you just have to be patient and roll with the punches.

Kevin Pho: So let’s talk about the KevinMD article that you wrote. It’s titled “3 ways technology in the ER boosts the patient experience.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Justin Schrager: Patient experience in the emergency department is tough, right? So working in the ER, as a nurse, doctor, tech, whoever you happen to be, you know that you’re working very hard all the time, just as most doctors do. But the time you have to update patients, to give them what they kind of want from a customer service standpoint, is not always there. The pandemic put extra pressure. Nurses were furloughed or fired in some circumstances. Volumes for ER patients went down dramatically and came back up. It’s a bit of a roller coaster chasing its tail, and so ERs are stretched thin.

So that extra little thing you can do for a patient, that extra step you can take, to pop in the room and say, “I’m sorry, the CT scanner is a little bit delayed because we have a few really sick people come in. That’s, you know, what you’re waiting on,” that’s kind of the first thing that goes out the window when you get really busy and stretched like this. Same thing for the nurses and the technicians and everybody else.

So the idea is, how can you use technology to provide patients with that information while they’re waiting, which is the information they want? It can help them sort of understand what’s going on in the background, lift up the veil a little bit. When they look out the window of the room or behind the curtain, they see people running around, but they also see us sitting at computers, and they’re wondering why you haven’t come in the room. And there’s really no reason why you can’t use modern technology to provide people with that information: “This is the status of your blood count. This is the status of your CT scan.” Or you’re sitting out in the waiting room and you’re seeing a lot of people come and go. You don’t know why this patient went before you, even though you got there before them. And those are common questions we get in the ER. So if you have a way to deliver that information to them in a way that they want it, which is on their phone, that should be used, right? And it should be used in the health care system. So that’s the genesis of the article.

We know from looking at national data that patient experience scores in the emergency department, especially, at least in the inpatient HCAHPS scores, are lower, about 20 points lower than people who are directed, for a variety of reasons. And for anyone that’s worked in the ER or gone through the ER with family members, you know why, right? It’s a tough place to be when you’re really sick and scared. So it seemed like an ideal patient population to sort of target with a software-specific intervention. They’re waiting, they need answers, they typically are using their phone, and we should avail ourselves of that. And we should be able to provide them with standard information that we would normally give any patient if they asked. It just takes an extra step. So that’s the technological solution.

And so in general, you hear that patients have increased needs, especially after the pandemic, where they can’t communicate with their family members. They’re not in the ER with their family members, so they want to share their progress without lifting a finger. They have increased expectations. People have been in their homes for a long time for the last year, and they’ve been using online ordering and all that stuff and things like that. So people are used to doing customer experience through their phone. Over 90 percent of patients in emergency departments have cell phones or smartphones, and they’re used to using them for everything from watching their oil get changed to their pizza being delivered to the groceries being delivered. Whatever it is, that’s where people go for information.

And so health care has been slow to adapt. Health care has been slow to, quote unquote, upgrade to the industry standard when you’re talking about reaching out to patients and just giving them general information. And if you really want to take it to the next level, which is what we’ve done in the ER, sort of put predictive analytics, put AI in the patient’s hands, rather than trying to modify clinical practice, things like that. Really just, “This is what you can expect, this is how busy it is right now.” And, you know, it does actually kind of help people understand, meet their expectations, and give them information that even the staff don’t always know, right? Like, they can’t give you an estimate about how long you’ll be in the waiting room, while, you know, machine learning can, and it can do it more accurately. So that’s the general background of the article.

And it’s sort of like a call to arms for health systems to sort of get with the times, right? It’s like every other service industry is doing this. It is possible to work with sort of third-party software vendors to do this type of thing for your patient population, and it pays dividends, right? So when you reach out to patients while they’re in the ER, they don’t feel abandoned. When you tell them what they need, like, “Your ER doctor said you need to follow up with this orthopedic surgeon in a week,” you tell them that before they leave, they’re not throwing away that packet of papers we give everyone, and things like that. And then there are a multitude of other things that you can communicate through software that right now would be difficult or tedious for ER staff. So it frees them up to do their normal job.

Kevin Pho: Now, for those who aren’t familiar with our world of HCAHPS scores and patient satisfaction, tell me about some of the financial repercussions of not having high scores.

Justin Schrager: Patient experience scores, broadly, there’s a national survey that was developed by Medicare that goes out to all the hospitalized patients, and you probably get it in the mail, or sometimes they do it by phone or email. And about 20-ish percent of patients return those scores. Depending on how well you do on the survey, there are financial repercussions for health systems, for hospitals. Hospitals have to administer a certain amount of the surveys, and if you do poorly compared to your competitors, because of value-based purchasing, basically what the government says is, if you don’t do a good job providing excellent care to your patients, and their experience of care is lower than it should be, the government will take money back from the amount of money that Medicare pays the hospital for standard medical care.

Kevin Pho: These technological solutions that you talk about, on average, how much do they raise these patient experience scores?

Justin Schrager: So it kind of depends on what you’re looking at. So the HCAHPS score in general, the top box score is what they call it, the average total score, has a lot of things in it, like, how clean was your room? You know, were you informed about delays? It has something called a net promoter score built into it, which is how likely you are to recommend this facility. That’s a very important metric.

So when you’re talking about software, software addresses some of those things. The software addresses the communication. It addresses setting expectations, timeliness of care, things like that. Obviously software won’t clean your room, unless it tells someone to come clean your room, or you interact with it and ask for them to come clean your room, which is something we have worked on. But at the end of the day, those scores go up depending on your facility and how poorly you’re doing, apparently substantially. So a few of our facilities that we’ve been working with have gone up 15, 20 percent. Some have seen 5 percent improvements; they were doing better to begin with. In general, it’s not harmful to your HCAHPS score, but it kind of depends on how you’re doing when you start doing it.

If you work at a facility, whether you’re an ER doctor, CNO, nurse, or, you know, a floor, practicing hospital, something like that, you know if your hospital does a good job communicating with patients when you hear it from the experience officer. You hear, “Hey, this patient said that nobody talked to them for two days,” or, you know, they left in the waiting room and nobody came to update them, and things like that. So those are the kind of messages that you would hear anecdotally that could clue you into the fact that, you know, there’s probably more your facility, or that you personally in your practice, could be doing.

Ideally, when you use one of these software solutions, like the one we built, it would be something that doesn’t ask your staff to do a whole lot, right? If it works in the background, it gives patients what they’re asking for from the experience standpoint, and the nurses don’t have to lift a finger. They don’t have to carry iPads around and do a bunch of extra work, because they’re already stretched thin. Then you’re going to get higher utilization numbers, meaning more patients are going to use it, and the staff aren’t going to have to worry about it as much. So that’s the idea, sort of like add value without subtracting workflow from the nurses.

Kevin Pho: We’re talking to Justin Schrager. He’s an emergency physician, and he wrote the KevinMD article “3 ways technology in the ER boosts the patient experience.” Justin, you mentioned earlier that a lot of health systems are slow to adopt technological solutions. Tell me, what is the path forward? What are some of the barriers that need to be overcome for these health systems to better adopt technology?

Justin Schrager: Health systems like new technology. I mean, they love testing out new things, you know, medical devices, things like that. Doctors love new things. I mean, right? You know, it’s like, “Oh, there’s this new technique, this new instrument, new way to do this thing in the clinical setting,” whether it’s a device or new medicine, things like that. We stay up to date on things. Frankly, it’s interesting that we’re in that world where there’s truly so much money in the health care industry to afford things like new software, and then there’s a desire on the clinical staff to use these things, new tools, new technologies, things like that.

I think one of the barriers, of course, is privacy, privacy, things like that, not wanting to be wrong, not wanting to breach that trust for the patients. So that slows things down a little bit from a compliance and safety perspective, and that’s very understandable.

I think some of the other barriers are that, frankly, we use electronic health records that are very good at what they do in terms of documentation, billing, things like that, right? But having used electronic health records, and I’m sure you’ve had lots of people on your podcast talking about electronic health records in the past, we know from lots of research that people spend twice as much time interacting with the EHR as they do at the bedside, plus a couple hours at home, right? You cut that in half and you have twice as many doctors out there, right? It’s a no-brainer. But I think that because they’re enterprise-wide solutions, they’re sort of locally installed, sometimes cloud-installed, they don’t update fairly, so, you know, you have a lot of downtimes and things like that, which is a little bit older. And so it’s a little harder for companies to build something that interacts with the electronic health record. And health care data is messy, can be hard to deal with, and it truly requires a physician or a nurse or somebody with health care data experience to kind of make sense of it. So there are additional barriers there that they don’t have in tech. You know, and I’m coming from a place of experience, where my co-founder is a fintech startup founder, right? So he’s done both of these things. There are barriers.

And then, you know, there’s the opacity of the health care setting. So if you’re building a patient experience piece of software, patients are using it, any person in the community can’t just log in and start using it, right? You have to be in the hospital to be using it. And so doing user testing and things like that is an additional barrier.

The general changes in health care have allowed for technologies to come around, and in some cases the government will work with the hospitals to do those. So HIEs are a good example of that, right? In general, you have to have some external forces to get health care systems to change broadly how they do technological things, because what they have now works, right? And they make money and they do well, and it has safety measures built into it. But if you want to take it outside the realm of documentation, databases that keep track of every little thing that happens in the hospital, it does require effort and a little bit of risk, right? You have to kind of go out on the limb, convince people in the hospital to buy in. Stakeholders are very rarely just one person in the C-suite. You have to convince the people that are going to be impacted at the point of care. So everyone from the registration clerk at the front desk of the ER, to, you know, the ER department manager, the physicians, all the way up the hospital, CNO, CMO, CEO leadership, have to be like, “OK, this is something we want to try and get behind.” So I guess that’s an additional barrier.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Justin Schrager: I would say that I’ve had a great time expanding my practice into an area that I never thought I would go into. I started my career as a researcher, a data scientist, epidemiologist, and through this startup, through working with software, integrating data science into software, and then ultimately moving into the patient experience realm, I never in a million years would have seen myself doing this. It’s opened up a whole world of possibilities for how I can impact patient care and sort of the general happiness of my colleagues and my nurses and friends in the hospital without them having to do anything extra. It’s also opened up opportunities for me to work with big companies nationally, like Sarah Cycle in that example, and sort of get the message out, build out something, and sort of create something from scratch that wasn’t there before.

If you’re interested in doing that kind of thing, it is absolutely possible. I promise you, 10 years ago I never would have said it was, but it is definitely possible, depending on how you want to get involved in this type of entrepreneurial activity, or even if it’s in an advisory role. It’s totally possible. Health systems are waking up to the idea of letting, you know, sort of letting us crazy startup-type things happen under their roofs, and it’s a new world.

Kevin Pho: Well, Justin, thank you so much for sharing your time and insight, and thanks again for being on the show.

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