No Digital Front Door:
Failing the Modern Healthcare Consumer

After Telehealth’s prime time moment during the Covid-19 health crisis, much attention this year has been focused back on the “digital front door” — the set of digital technologies through which interactions of the Modern Healthcare Consumer with their healthcare providers are enabled.

But according to a recent survey of over 1,000 adult patients in December 2022, only 17% of patients felt that the “experience accessing healthcare is getting better”. Which in the context of a mostly ad hoc rollout of telehealth and telemedicine offerings is shockingly low. 21% of patients even thought it was getting worse and given the state of access in the last 2 years prior, even 62% indicating “the same’ are not laurels to rest on.

On the provider side, and this may provide an insight into the dismal patient experience, things are worse: 47% of providers felt that access was getting worse over the course of 2022.

Digging Further Into the Data

Before we throw the telehealth baby out with the end of the public health emergency, let’s take a deeper look at the key root causes of “frustration with access”.

On the patient side the top three pain points were time to appointment (78%), fitting an appointment into one’s personal schedule (49%) and the process to schedule appointments (40%).

On the provider side the top pain points were staffing shortages (87%), the continuing confusion caused by the pandemic (64%) and the challenge of cost estimates (63%).

What’s revealing is that 76% of patients declared they’d want to schedule appointments online and 56% want more digital options for managing healthcare. Thus the majority of patients are ready for more digital access, despite the reluctant attitude by many providers.

Yet only 46% of the respondents on the provider said that the expect organizations to invest more into digital front door technology.

Another aspect of the survey also focused on the Modern Healthcare Consumers’ desire for more price transparency, which, as providers pointed out, is not trivial to determine.

The Digital Front Door, widened.

While the term “digital front door” was historically focused on the online patient portal provided by EMR vendors, allowing patients to see physician notes and lab results and communicating securely with their care team, healthcare’s digital front door in 2023 encompasses many other technologies involved in the delivery of care.

Here are just a few of the tasks that the Modern Healthcare Consumer expects to accomplish digitally, that should be part of a healthcare provider’s vision for their digital front door:

• Schedule appointments online and search for provider
• Communicate with the care care team on non-clinical aspects.
• Receive accurate cost estimates
• Receive care through video visits.
• Communicate with providers through secure messaging
• Access clinical notes, lab or test results, immunization records,
• Manage prescriptions
• Complete and sign forms or questionnaires
• Receive vetted education related to diagnoses or procedures
• Managing bills and payment options

Telehealth to Increase Access

While telehealth is not a panacea for these challenges, it can certainly help organizations to significantly alleviate some of the challenges outlined in the report. Telehealth appointments can be set up and started literally in minutes, whereas an in-person appointment requires the patient to be on the premises and staff available to room the patient.

Assuming that actual provider work load is not at 100%, telehealth offers a great opportunity to convert (1) cancellations into telehealth visits, (2) no-shows into tele-late-shows and (3) schedule holes into telehealth visits with patients who otherwise would have to wait weeks to get in.

Especially for the latter scenario, technology can greatly help to automate the process, e.g., through automated text messages: “an appointment is now available at 3 PM, first come first serve, click here”.

A note on the cancellations: I’m making the assumption that patients in many cases could still carve out the 10-15 minutes for a tele visit from home, from work, or from the parking lot, if they don’t have to leave work early, don’t have to hire a babysitter, or don’t have to arrange for transportation.

For health centers or health systems with multiple clinic locations, telehealth can also be used for “load balancing”: if one clinic’s provider capacity is limited, other providers at other clinics can conduct “site-to-site” visits vs. having to cancel a patient due to a provider that is unavailable.

Finally, patients desire to access care outside of their working hours is a convenience that many Modern Healthcare Consumers are yearning for. When providers are set up to conduct telehealth visits from home, the flexibilities for after-hour or weekend care are endless, without having to “keep the doors open and the lights on” in the brick-and-mortar infrastructure.

Telehealth Optimization Guidance

For telehealth to work well in a spontaneous, ad hoc environment, multiple aspects of the telehealth experience must be optimized.

In our experience, patient satisfaction with their video visits can be directly attributed with the physician’s willingness to consider telehealth as a viable alternative care delivery modality.

As I wrote in the summer of 2020 at the height of Covid: “when physicians enjoy doing telemedicine, patient satisfaction improves, patient engagement increases leading to better health outcomes.”.

The recipe for great telehealth experiences is deceptively simple and technology is only a small part of it.

Here are the five elements that need to be optimized before you can go full-scale of utilizing telehealth at a moment’s notice as outline in the 3 scenarios above:

1. Defined Workflows – telehealth is a series of 7 processes and if in a digitally connected environment those are not properly defined, everyone’s experience will suffer.
2. Adequate Technology – you don’t need fancy bells and whistles, but the basic features and appropriate user experience are a must.
3. Proper Training – delivering “care at a distance” is fairly new and not taught in medical school; but training is also needed for front office staff and nurses.
4. Responsive Support – with more moving parts, more things can go wrong process-wise and technology-wise; well-skilled support has to be on speed dial to be able to solve problems in real time.
5. Committed Leadership – change starts at the top, and if the leadership team does not fully buy into the “digital (r)evolution of healthcare”, neither will the providers and the patients will suffer.

A Reusable Approach

Accelerating the adoption of digital health innovation should be on every healthcare leader’s mind and the 5-ingredients recipe above is universally applicable to any expansion of the digital front door, not just telehealth.

The biggest challenge is knowing which of the multiple facets of the digital front door to pay attention to in light of limited resources including staff, money, and time.

Reach out to Christian to explore in conversation how even in these trying times, your organization can implement innovations successfully and sustainably.