Using Information Technology to Provide Great Service

Helping patients manage their health requires developing superior IT-enabled services. How should health care providers tackle this challenge?

Services enabled by information technology (IT) are all around us. We can turn on the heat or the air conditioning in our house when we leave work, so it’s the ideal temperature when we get home. We can open the garage for the cat sitter back in Boston while we’re sitting on a Cape Cod beach — and close it after she leaves. Our airline app can reassure us that our bags made it onto the plane, or let us know which flight they’re on instead. Our devices suggest songs we might like, or gifts for our loved ones, or the best route for bypassing road construction.

Sometimes the IT-enabled service doesn’t quite cut it. The app that routes you past construction doesn’t know about the closed road where it wants you to turn left. The “smart” thermostat dials down the heat when it thinks no one’s home, but doesn’t realize it’s left you shivering in the basement. You comb the Internet to find the perfect birthday gift for your great aunt who collects elephant figurines, and suddenly your social media is all elephants all the time until you appease the algorithm by buying new sneakers — which it then advertises to you 24/7, apparently hoping you’ll buy them again.

These types of gaffes aren’t quite bad enough to make us long for the old days before our computers and phones took over our lives and redefined convenience forever. But they are the equivalent of a restaurant with disappointing food and slow service. At best, you don’t leave much of a tip; at worst, you demand to speak to the manager. And you certainly don’t rush to go back, even if they try to make it up to you with a gift certificate toward your next visit.

IT can enable new types of health care services and markedly improved current ones. Health care providers realize this, and they also understand that good service can impact reimbursement and should attract patients. In fact, many providers have established leadership roles such as chief experience officer or chief digital officer to lead efforts to advance IT-enabled services.

Unfortunately, health care harbors more than its share of quasi-helpful IT. Despite the rapidly growing use of patient portals and apps, a health care provider risks irritating its customers with confusing bills, repeated requests for the same information, or long and inexplicable waits (to check in, to check out, to be admitted or discharged, to be examined or get an X-ray, to get word on a loved one’s condition).

A health system’s website may offer “online appointments,” asking patients to submit a lengthy questionnaire only to be informed that a representative will call within 48 hours. For true online appointments, take a look at the phone app ZocDoc. It may not have the doctor you want, but if it does, you can book the next convenient slot in seconds and have a reminder sent to your calendar.

A popular patient portal app lets patients handle their copay online. A friend of mine tried to use this feature recently, only to find out that the app had collected an incorrect amount. The health system rejected the payment and mailed her a bill, thereby vastly increasing the administrative overhead rather than cutting it to almost zero. If any of a health system’s applications know what the correct copay is, they should all know it. If they don’t, they should stop pretending they do.

All providers want to offer services as innovative and high quality as those of Amazon, Uber, Airbnb and Venmo. And providers cringe when they hear stories of poor service such as those above — especially when they hear them from their own patients. How should health care providers tackle the challenge of developing superior IT-enabled services?

Processes and data

First, all efforts to improve service must focus on two areas: processes and data.

Customers primarily use processes to judge an organization’s performance. A restaurant must have excellent food preparation and prompt, attentive service. A health care provider must make it easy to get an appointment, communicate with clinicians, and pay the bill. Often a few processes have a disproportionate impact on customer satisfaction; those are the ones an organization must find ways to improve.

For these key processes, providers should make sure that they separate method from intention. For example, when banks started to adopt consumer-facing IT, they put ATMs outside their doors because they were defining their intention as “getting cash from the bank.” They later refined the intention as “getting cash,” by placing ATMs anywhere that people needed to get cash, like the airport or the mall.

Debit cards shifted the intention from “getting cash” to “buying things.” It turns out that “buying things” was the true intention all along, and getting cash was merely the method, which changed as technology developed but without altering the underlying intention. Providers can manage change more effectively by recognizing when they need a new method to address an existing intention, and when they need to adopt a new intention.  

Customers may not be directly aware of data, but providers need it in order to deliver great service. Data tells you whether the service is great, and if not, why not, by showing you wait times, satisfaction scores and call-abandonment rates. If the service is substandard, data can pinpoint the source of the problems, such as inadequate staffing.

Data can also be used to help tailor the service. For example, data enables retail websites to suggest items that “people like you also bought” and determine the impact of various attempts at personalization.

Data enables you to understand your customers: not only their demographics but also their core values and beliefs, how best to motivate them, and how much control they want over decisions about their health. This use of data underlies the recent interest in social determinants of health, where good data is crucial if we are to provide the best health care possible.

Frameworks

Second, addressing service requires that the organization adopt one or more frameworks that it uses to approach service creation and improvement. For example, many organizations have adopted the framework of a “journey,” where the traveler’s needs change at different stages in the journey. A young woman may be on a journey to raise a family: becoming pregnant, engaging in prenatal care, giving birth, settling in with an infant, and raising a growing child. Each stage of this journey brings different needs and different service demands. Fertility services may be important in one stage, while breastfeeding guidance is important in another.

Some frameworks center on a single transaction. Buying a book or changing seats on an airplane should be a great service experience; but neither involves a journey, so improvements must focus on a small set of processes around that transaction.

Evolving IT

Third, service leaders must understand that IT will keep evolving. Providers should develop a routine for examining each IT innovation in light of the organization’s service goals and asking, “Can this technology help us materially improve our services and, if so, how does it do that?” Not all service gains require cutting-edge technology; but new technologies can lead to impressive gains in service, like GPS-enabled mobile apps that have transformed the process of hailing a cab.

A holistic approach

Fourth, service improvement should be approached holistically. All the factors discussed above — clearly defined intentions for each process, well-designed processes, adequate data, appropriate frameworks and new technologies — must combine with a service-centric organizational culture that establishes accountability for excellent service and rewards it accordingly.

Defining our ultimate organizational goal surrounds and shapes these factors. For most banks, the overarching goal is helping customers manage their entire financial lives. Helping us access our cash in order to buy things is only a small part of achieving that goal: At various times on our financial journey, we may also need credit cards, student loans, a mortgage, a safe-deposit box, or investment services.

The move toward value-based care gives us perhaps the clearest ultimate goal that we have ever had: to make it as easy and inexpensive as possible for our patients to stay as healthy as possible. In achieving that goal, health care providers may change as radically as banks have.

Health care providers must evolve portals, apps and other patient-facing IT the same way banks evolved their financial services — by working to achieve their ultimate goal, while making sure each step of the way improves the experience for our customers, the patients. Once they make their first appointment online using a properly designed app, many patients will never again wait 48 hours for a representative to call, or even call the provider themselves and sit on hold. By the same token, if their pharmacy’s automatic refill service keeps refilling a prescription they’re no longer taking, it’s not worth the trouble, no matter how high-tech it is.

We might use technology to eliminate most office visits — saving them for when they’re really needed — in favor of care based in the patient’s home or office so that they don’t have to disrupt their entire day. Continuous monitoring might replace a lot of routine testing, and e-visits might become the standard method for therapy and other contexts where the conversation is the care.

To start on this journey, I suggest the following:

• Experience every aspect of your organization as a patient, and see where your current technology is and isn’t working. Do you get asked the same questions over and over? Do you get tired of listening to your own “on-hold” music as you wait to make an appointment or get a simple question answered? Can you understand your own test results on your patient portal? Is it easy to understand (and pay) your bills? Everyone who works on patient-facing technology should use it — to see for themselves how smart it really is.
• Think about where you can make your processes smarter. For visits that always require labs, can your appointment app help the patients schedule them in advance, and send them a text reminder not to eat after midnight? Can you automatically alert a patient’s family members an hour before she’s ready for discharge?
• Invite feedback, and make it easy to give. Think star ratings, like Yelp.

Health care providers must increasingly help patients manage their health throughout their lives. Achieving that goal requires developing a collection of great IT-enabled services. To get there, we need to understand what our patients consider to be great service, whether or how we’re falling short, and how technology can help us bridge the gap.

John Glaser, Ph.D., is senior vice president of population health with Cerner in Kansas City, Mo. He is also a regular contributor to AHA Today.