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Enhancing the Patient Experience using Mobile Technology

Insight from a physician-entrepreneur

By: Michael Warner, MD, FRCPC, MBA

President, AdvisoryMD

The long-term success of businesses in most industries is influenced by the balance between supply and demand. Medicine is different. Physicians and hospitals are in limited supply, and there is an unrelenting demand for services. As a result, there is little economic motivation to improve the patient experience.

Widespread use of mobile technology has shaped consumer expectations in nearly every retail industry. To remain competitive, transactional businesses must offer convenience and low cost. Service-based companies strive to provide customers with a personalized, hassle-free experience.

Unfortunately, when it comes to interactions with the healthcare system, consumers have been conditioned to dial back their expectations. The process of accessing a physician can be inefficient and inconvenient. Once patients have entered the healthcare system, communication can be incomplete and provider-centric.

Consumers' improving experience in other industries has raised expectations for their experience as patients. Fortunately, there are several companies and organizations profiled below who are using mobile technology and principles from other industries to improve both access to, and communication within, healthcare.

Improving Access

It has been widely reported that Canadians wait longer to see a physician than patients in other highly developed countries. The reasons for this are complex and not solely due to the way physicians operate. Factors such as human resource planning, fee schedule rules and lack of integrated healthcare IT are all contributory.

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Although physicians are not necessarily responsible for poor access, they may be affected by innovative solutions designed to improve it. Most publicly funded provincial healthcare systems do not remunerate physicians for providing a comprehensive range of non-urgent telemedicine services. This gap has created space for several companies to sell access to virtual physician consultations.

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The telemedicine industry in Canada is still in its infancy. Provincial organizations, such as the Ontario Telemedicine Network provide access to a narrow suite of services using proprietary technology. Relatively new companies, such as Quebec-based Dialogue Technologies, work in the B2B space, marketing access to telemedicine as a cost-saving employee benefit. Toronto-based Maple, sells virtual consultations directly to consumers who are looking for a convenient alternative to sitting in a waiting room.

By comparison, telemedicine is well established in the US. Companies such as HealthTap and Doctor on Demand have raised a combined $120 million in venture capital funding. Teladoc, launched in 2002, is the nations' largest telemedicine provider and is publicly traded. American physicians can even purchase telemedicine insurance which allows them to care for patients in multiple states.

Telemedicine is not a viable platform for managing all medical issues. A complete physical exam cannot be performed through a video call and lab tests and imaging are required to diagnose more complex problems. Continuity of care for chronic disease management is also difficult to achieve. However, US data shows that ~25% of all ambulatory clinic visits do not require a physical exam, lab test or diagnostic imaging investigation.

The expansion of telemedicine throughout Canada may not be as rapid as it has been in the US. The Canadian healthcare system is more accurately viewed as 13 different systems: 10 provincial and 3 territorial. Jurisdictional barriers make it difficult for patients to receive care and for physicians to provide services across provincial borders. Physicians, however, should monitor the industry closely. The types of patient visits most commonly managed through telemedicine are the most straightforward visits seen in an office or walk-in-clinic. If these "easy", high volume visits are diverted from bricks and mortar clinics, remuneration for clinic-based physicians will decrease.

Improving Communication

When I call my children's pediatrician's office, there is no chance I will speak to a live person. They do not answer the phone. The only option is to leave a message and hope they call me back at a time I am not with a patient myself . In a world where I can book a dinner reservation online in 30 seconds, this type of asynchronous two-way communication seems antiquated. For many patients, however, the only way they can interact with their physician's office is through a similar provider-centric system.

Barriers to entry exist in business but should not exist in medicine. Patients should expect seamless, convenient and informative communication with their physician's office. Recognizing that barriers to communication can impinge on access, Avocare, a Toronto-based start-up, has created an automated virtual assistant for medical reception supported by Artificial Intelligence. Patients communicate with the Avocare Chatbot to book appointments, follow up on test results and request prescription refills. The bot can handle most questions so patients do not have to call the clinic.

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The automobile manufacturing industry uses the Just-in-time inventory strategy to increase efficiency and decrease waste by receiving goods only as they are needed in the production process. Just-in-time delivery of patients, however, is rare in medicine. Most clinics dedicate up to 50 % of their square footage to a waiting room. This is expensive for physicians who commonly lease space on per square foot cost basis. Queuing in a waiting room is also an inconvenient waste of time for patients.

In an attempt to facilitate Just-in-time delivery of patients, the Singapore General Hospital has released their SingHealth Health Buddy mobile app. Through the app, patients register for specialist appointments, obtain a queue number and gauge their waiting time through live updates. Patients are happy because their living room becomes the waiting room. The hospital can then dedicate more space to clinics by downsizing waiting rooms and removing registration areas.

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It is important to remember that improving communication in healthcare also includes improving communication between the healthcare team and the patients' friends and family. Humber River Hospital in Toronto is the first surgical program in Canada to use the STERIS RealView patient tracking system. This system allows a patient's loved ones to follow their surgical journey through real-time text message alerts. Updates are sent when the surgery starts and ends. A final alert is sent when the patient is ready to receive visitors.

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Physicians and other stake-holders in the healthcare industry should be encouraged to introduce and adopt simple, cost effective mobile technology solutions to improve access to care and communication. Lessons learned from other industries, when applied to medicine, can improve the patient experience and the relationship between physicians and hospitals and the patients they serve.

Michael Warner is the President of AdvisoryMD. He provides healthcare entrepreneurs with medical advisory/director services and also performs clinical due diligence for investors evaluating healthcare companies.