The modern conveniences of the 21st century have touched most areas of our lives. As just one example, think about how fueling up for the day has changed. You can use an app to send your order to Dunkin’ Donuts or Starbucks, so that everything is made just the way you like it, and pay with one click. Then when you get to the shop, you bypass the long line at the front, and head right to the mobile orders section, picking up your items without needing to talk to anyone.
And consider the changes on the other side of the counter as well. Employees can get your digital order beamed directly to their screens to prep it exactly right and on time. No more scribbling a misheard version of your name onto a cup, or handwriting your preferences (half-caf? sweetener instead of sugar?) onto a paper slip that gets handed down the line to the barista who might not be able to read it clearly. When customers order ahead, the employee doesn’t have to spend time taking their cash and counting out change, speeding up the entire experience—which is a good thing for everyone in the transaction (and the other people waiting in line).
But for some reason, conveniences like these haven't made a big mark in the health care setting yet.
Why can’t health care be like so many other aspects of life: easy, convenient, and efficient? At Penn Medicine, efforts to rethink and simplify the care process are doing just that.
“Penn is really focused on thinking about efficiency for health care workers across every spectrum,” from clinicians to frontline staff to those who work behind the scenes, said UPHS Vice President Raina Merchant, MD, MSHP, Penn Medicine’s chief transformation officer, associate vice president, and director of the Center for Health Care Transformation and Innovation. “We’re trying to reduce repetitive tasks to make the work that employees are doing meaningful, allowing them to operate at the top of their license.”
Eliminating Hidden Hurdles
Consider paperwork as one example. Before a new patient visit, care coordinators are responsible for collating their health records from various sources, an endeavor that could take more than six days, between obtaining the patient’s consent and interfacing with other care providers. Until recently, part of that process may have also involved handling faxes (from care providers with different health record systems); each fax would have to be manually processed and the information it contained typed in by hand. “At a system-wide scale of nearly 24,000 faxes per day, processing faxed documents consumes a lot of valuable personnel time,” said Jency Daniel, DNP, MSN, RN, senior innovation manager with the Penn Medicine Center for Health Care Transformation and Innovation.
Such an inefficient system cried out for improvement. Penn Medicine has introduced several, piloted by the Heart and Vascular Center, the Abramson Cancer Center, and many other departments and divisions. The improvements include a SmartForm in Epic and eConsent, a new documents management system to electronically collect patient consents and neatly assemble records, easily accessible from our electronic health record system, PennChart. These programs have reduced the time to collect patient signatures for records collection to less than a day, with approximately 60 percent of signatures obtained within one hour, according to Daniel.
A similar process has been put in place to manage faxes: homegrown software called “coordn8,” which uses optical character recognition and natural language processing to speed the processing of faxes received from outside Penn Medicine. It has reduced the time to input each fax from an average of three minutes to just about half a minute, which results in less burden on staff, and consequently lower processing costs. The software is projected to save the health system approximately $5 million annually, “about five times the savings in comparison to an external vendor with less features,” said Emeka Anyanwu, MD, MSc, clinical informatics manager with the Center for Health Care Transformation and Innovation and associate director of the Center for Cardiovascular Informatics. It also gives staff back time in their day to spend on other things, such as providing care for patients.
No More Clipboards
While these process changes have happened in the background, others are immediately obvious to patients. This summer, contactless check-in—the ability to pre-fill outpatient questionnaires and privacy and payment forms, input insurance information, and pre-pay for visits—expanded beyond just registered users of myPennMedicine and MyLGHealth. Now, even patients who don’t have accounts with these platforms can finish all of their paperwork before arriving to their appointment, doing away with the need for clipboards full of forms that have traditionally been part of the check-in process in some offices. (Patients whose forms aren’t filled out ahead of time may still complete this step of the process in person, but with a paperless, digital signature system.)
Further enhancing the experience—for both patients and staff—is the one-click sign-in option. Patients who are within a certain range of their appointment location receive a text message prompt to click “I’m here” in the digital portal. When they do, they’re instructed to bypass the front desk and have a seat. Meanwhile, staff receive a message that the patient is present, so they know who’s in the waiting room, and are able to greet them by name.
“It allows staff to actually look up from the computer and establish a warm connection with a patient,” instead of barraging them with questions, said Heather Landis, practice manager at Lancaster General Health Physicians Family Practice Manheim. She added that not spending significant amounts of time checking in patients frees staff up to attend to other duties, such as making reminder calls to patients about upcoming appointments.
At the same time, most Penn Medicine offices have also gone “cashless,” meaning they don’t accept money or checks for payment. (Those which sell products, such as optical shops and certain dermatology practices, are exceptions; and hospitals will still have cashiers for patients who use cash.) Patients are now encouraged to prepay online, but they may still pay in person with a credit or debit card or elect to receive a bill in the mail.
Rather than all the tasks involved with accepting cash—keeping track of money and checks, settling up at the end of each day, and physically transporting it to a deposit location—staff can instead spend more of their time assisting patients with other registration needs or questions. “I truly love the cashless/paperless initiative so much in that it allows me to focus on other priorities,” said Zhang Thai, patient service associate at Penn Medicine Radnor.
Danielle Werner, MHA, chief operating officer of the Clinical Practices of the University of Pennsylvania (CPUP), said that through these projects, “We hope that we can enable staff to focus on patients with more complex needs, or to reach out to patients and confirm they’re able to make appointments, so if they can’t make it, we can reschedule them and ensure that their spot is filled by someone else.”
Doctors Without Burdens
An early “win” of the effort to make providing care easier for care teams—and more seamless for patients—is a recent agreement between Penn Medicine and Independence Blue Cross to eliminate preapprovals and prior authorization for scans ordered by certain doctors. This means more than 1,200 physicians with a good track record of following the insurer’s guidelines will face fewer hurdles to get their patients approved for CT scans, PET scans, and ultrasounds, and patients will be able to get into Radiology appointments more quickly.
The innovation continues to the exam room. In outpatient offices, Penn Medicine is testing out “ambient listening”—essentially, using software on the doctor’s phone or computer to “listen” to the visit. In this case, the program takes the place of a human scribe to record the conversation between doctor and patient, including any remarks the doctor makes in the course of their exam and about labs and scans in the patient’s records. This saves the physician from needing to complete their notes after the patient’s visit—a practice that often results in using “pajama time” to catch up after the workday has ended, according to Merchant—and allows them to spend the visit more closely focused on the patient in front of them.
“The daily workload of the doctor has increasingly become cluttered by 'low value' activities that serve regulatory, billing, clerical, and other goals and compete with or detract from actual patient care,” said Penn Medicine’s Chief Medical Information Officer, C. William Hanson, III, MD. “Ambient listening will cut down significantly on the document burden that contributes to provider burnout.”
Staff can expect more innovative efforts along these lines, without cutting corners where quality counts, said Merchant: “Not only do we want to be the easiest place to work, but to also maintain our excellence at providing the highest-quality, most evidence-based care.”