The healthcare industry is undertaking the digital transformation journey. Health systems have an opportunity to facilitate a smooth, convenient consumer experience, supported by more efficient operational workflows. They are rightly seizing the opportunity to reduce information technology bottlenecks, administrative burdens, and revenue cycle breakdowns. Those that digitally transform their networks first will be winners, while followers will be hard-pressed to dislodge the first-movers from their market share.
However, digitizing a health system requires comprehensive data management of their care delivery assets to make the journey. To cross the digital chasm, health systems need a key enabling technology: an advanced digital information management platform.
Following retail’s example
In the retail world, the customer journey required consumers visiting brick-and-mortar stores, where they would cruise aisles and examine available wares. Associates would offer assistance, hoping the customer would find something that met their needs.
Then retail moved online, of course, and the entire paradigm shifted dramatically. Consumers increasingly shop online to have goods shipped directly to their house—faster and more conveniently than driving to the store, with no compromise in selection or price. Amazon is the most obvious example: a company that has completely disrupted the retail journey, offering consumers an entirely new digital experience.
Healthcare is now undergoing its own digital transformation. Within the past year, 72% of consumers say they have looked for health information online. And these searches largely began online via the big search engines—77% of these relying on Google, Bing, and Yahoo rather than a medical center website. As happened in the retail space, these ‘shoppers’ are also going mobile, with 52% of smartphone owners now using mobile for searching for health or medical information.
Facing this new reality, provider organizations are racing to grab digital mindshare, and the goal is a better experience. While retailers managed this transformation by focusing on the customer journey, for healthcare it’s all about the patient—now ‘consumer’—consumer journey. Health systems must pivot and become wholly digital organizations; this transformation requires providing a similar journey which their consumers have come to expect when buying retail.
In transitioning to digital, retailers quickly learned an invaluable lesson: the new paradigm requires full digitalization throughout the experience. This starts at the beginning, of course, and requires digitally-dependent processes—product research, shopping, purchasing, payment, and digital tracking of fulfillment—that each individual customer experiences.
Likewise, healthcare must start at the very beginning, and support each stage of every patient’s process with digitized data. The operational breakdowns for a health system, as we’ll see shortly, are largely a function of the clinical network’s data being siloed and incomplete.
A single digital footprint
Amazon.com’s core success is arguably due to its maintenance of a continuously updated digital catalog that reflects its entire product offerings and is searchable in real-time to meet the needs of customers who want to buy what they want, when they want.
What would this look like for a health system? A care delivery network must similarly digitize all providers, places, virtual visits, and clinical procedures, as well as the health plans and networks in which they participate. All of these must be properly digitized, profiled, categorized, and curated for both consumer search and operational needs across the enterprise, shared across an omni-channel world.
Lacking this single digital footprint, a health system—like a retailer without a fully digitalized front-end customer journey—won’t realize the full value of its clinical assets. Examples:
- Consumers won’t find and book an appointment with the right, convenient provider that has availability and accepts their health plan or is in network.
- Reg/sched and patient access teams will experience the dreaded ‘provider not found’ in electronic health record or related systems, causing disruptive, costly downstream provider research and data entry, and delaying claims submission, receivables and cash flow.
- Referring providers or patient access teams won’t have an accurate, full view of specialist choices, impacting the consumer experience and revenue realization, if patients unwittingly go out of network.
- Revenue-generating value-based care teams won’t have tools to efficiently build, launch, maintain, and market multiple ACOs, clinically integrated, and narrow networks.
Just as Amazon.com offers a full online product catalog to enhance product search and purchase (see Figure 1 below) on its consumer-facing website, health systems need to achieve an analogous experience and robust data set about its products – its care delivery network.
Despite this new reality, most health systems today still present themselves to consumers utilizing an inward-facing, brick-and-mortar model. Their website offers up names, phone numbers and addresses of hospitals and clinics, lists their lines of service, and offers patients a simple alphabetical directory of physicians. These efforts put the onus on the patient to search the health systems and get the right care—a poor first step in the consumer journey.
This approach ignores lessons learned by retailers going digital: that sellers must present their offerings in a consumer-centric way. Healthcare offerings should be searchable using consumers’ key parameters, including the consumer’s complaint or condition, health plans or network, proximity, scheduling availability, male or female provider preference, and more.
Healthcare will not, of course, go completely digital. There remain critical aspects of care delivery that will always be done in person. But health system leaders are now offering coordination of every patient’s journey in a virtual, self-service manner, using digital tools to find their own care. A recent Accenture study showed that nearly 70% of younger consumers—and nearly 60% of older consumers—are more likely to book an appointment with a provider offering online booking, changing or cancellation capabilities.
Take virtual medical visits, which are now becoming standard fare in healthcare—insurance companies are now paying for them. CMS has introduced telemedicine billing codes for designated rural areas under Medicare; some commercial payers have followed suit. So patients can look up a provider, schedule visits, get advice, order a prescription—all from their mobile phone. It’s the same way they would summon a ride from Uber, or order items from Amazon—on-demand, with immediate delivery and total control.
A fully digitized patient journey
The healthcare world is now one of consumerism, so the healthcare industry’s vision should be for a fully digitized patient journey.
How do we make that happen? First, health systems must turn their care delivery network into a single digital representation searchable by consumers, providers, staff, and partners. This vital step ensures that the end-to-end patient experience (both clinical and financial flow) can be as frictionless as possible. The result is greater efficiency. As long as departmental siloes exist— not to mention spreadsheets or paper records—and contain needed information about providers, locations, the health plans they’re on, and other information, breakdowns and inefficiencies will remain.
With these digital care delivery assets consolidated, health systems must deploy them in key workflows, including consumer search, appointment booking, and call centers where many patients still access health care. The good news is that health systems have deployed electronic medical records and revenue cycle systems—both of which rely on these digitized assets to support registration, delivery, documentation of care and referrals, including searching for appropriate, convenient and in-network specialists, imaging centers, laboratories, or other services.
Deploying the right provider platform to guide the patient journey
To digitize their clinical network, health systems should deploy an information management platform that curates and shares clinical network data. This platform should include these capabilities:
- Digital profiles for all providers—employed, referring, and affiliated—and locations to manage network and health plan participation, clinical interest, availability and other information.
- Tools to continuously curate and maintain robust profiles, by staff research and updates, feeds from external authoritative sources, and digital outreach campaigns that enable providers or designees to securely update their provider or location profiles.
- Value-based care plan management capabilities that support unlimited numbers of plans as well as the individual providers’ participation in these plans, including roster management, reporting, and microsites for consumers and staff to search for or coordinate care.
- Service line management powered by a thorough and detailed clinical taxonomy to categorize individual providers by specialty, subspecialty, clinical terms, and consumer-friendly search terms, while maintaining the health system’s existing lines of service and subspecialties.
- Securely share this digitalized information via API or interfaces to both internal customers (health system websites that offer Find a Doctor search capabilities, EHRs such as Epic and Cerner for billing purposes, patient access systems for care coordination) and external customers (individual consumer-members of a clinical network, or employer-hosted websites supporting narrow network participation).
- A national repository of pre-built profiles of all providers, supporting a simple enrollment process as providers join CINs, ACOs or assume new health system affiliations, and eliminate lengthy revenue cycle delays, caused by referring providers not available in the EHR.
Such a platform should support the patient journey by aligning what has previously been siloed provider data management. Maintaining a single digital footprint of a health system or clinical network helps patients navigate a “physical journey” while also supporting the “digital journey.” This data management platform eliminates information silos, ensures accurate, continuously curated information, and improves operational performance. The total digitization of our clinical networks represents a much-needed digital transformation for healthcare to achieve a long-sought promise of better outcomes at affordable costs.
Tom White is CEO of Phynd Technologies