Why Healthcare's Unique Document Requirements Make it Harder for...
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Why Healthcare's Unique Document Requirements Make it Harder for Patients to Seamlessly Interact with Providers

By Rich Temple, VP & CIO, Deborah Heart and Lung Center, Browns Mills, NJ

Unique Document RequirementsRich Temple, VP & CIO, Deborah Heart and Lung Center, Browns Mills, NJ

There is an ongoing discussion in the healthcare industry as to why healthcare hasn’t embraced new technologies and new ways for customers/ patients to interact with providers as other industries have. Why can’t a patient just book an appointment in much the same way that customers book restaurant reservations on OpenTable or airline reservations with their preferred airline?

It is a worthy discussion because patients are expecting that type of ease of interaction but what isn’t always obvious to patients is that appointments with healthcare providers require a lot more documentation and “authorizations” in many cases than these other types of modern-day mobile-phone based interactions. Working these extra documentation requirements into an online user interface is not all that straightforward.

Let’s look at an example of a patient who would like to book an appointment with a cardiology specialist. In order for the medical office to fulfill this appointment and have a high level of confidence that they will be paid for it, they will need to have a few documents readily accessible to them prior to the patient’s arrival. Very likely, the patient will have insurance and the office will need to see the insurance card and contact the insurer to ascertain how much of the cost of the visit the insurer will pay and how much will be coming out of the patient’s pocket in the form of deductibles, co-pays, or co-insurance. The office, generally, will want to see a physical copy of the insurance card. Yes, it can be uploaded via a scanner but, if that capability does exist on a provider website, it is an extra step and it must be done securely to be compliant with the patient privacy requirements of HIPAA legislation. Many insurances also require pre-authorization for certain types of medical services and the medical office will have the onus of receiving a formal document from a referring physician, retaining that document in an electronic format (although these documents are often faxed or printed), and forwarding that to the insurance company to receive the authorization for the patient’s visit. This aspect of the patient-physician interaction also complicates the needed workflow for patient’s online appointment capability.

Furthermore, Document handling–and the inefficiencies intrinsic with healthcare document workflow–plays a role in making online appointment registrations extra tricky. Patients often need to present written “scripts” from referring physicians at the time of their appointment so the medical office has the appropriate background and knows how to send the results of a medical visit back to the physician who referred the patient for the visit. Capturing the “script” prior to the visit and ensuring that the results of the visit go to the right referring physician, in the right office, in a HIPAA-compliant secure manner is not always a clear-cut undertaking and are major contributors to why healthcare remains one of the last bastions of the fax machine in modern industry. While e-faxing, cloud faxing, and other more “advanced’ forms of faxing are beginning to gain a toehold in healthcare, the healthcare industry still has a long way to go to catch up to other verticals in terms of how information and critical documents are exchanged.

Oftentimes, entire medical records need to be sent to the medical office prior to a procedure or more complicated encounter. A patient generally will not have those at his or her fingertips (although this is starting to change somewhat with the advent of electronic web-based patient portals and initiatives such as Apple Health which offer consolidated medical records to be securely stored on a patient’s iPhone). So those records need to be requested in advance of the visit and, those documents, as well, must be sent securely and must be sent in a manner that makes it easy for the healthcare provider to be able to access the most pertinent information easily for the patient’s encounter. Some medical records can be thousands of pages and one can see how “information overload” can detract from the proper care of a patient if the information presented to the provider isn’t well-curated before provider sees the patient.

"While e-faxing, cloud faxing, and other more “advanced’ forms of faxing are beginning to gain a toehold in healthcare, the healthcare industry still has a long way to go to catch up to other verticals in terms of how information and critical documents are exchanged"

Even with these headwinds, healthcare is hitting a tipping point where these challenges are beginning to be overcome. Consumerism and modern new technologies are indeed creeping into the healthcare space and electronic health record (EHR) vendors and specialized third-party vendors are beginning to offer more advanced functionality to address the interchange of clinical data between providers and patients. Apps such as OpenTable and Uber/Lyft, while not directly involved in healthcare, are requiring that healthcare think differently and focus on the totality of the patient experience at all touchpoints between providers and patients and their families. Everyone involved in the healthcare process will win as a result of this consumer-focused transformation. 

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