Patient Pathway Digitisation – More Than Meets the Eye

As consumers we have come to expect a hassle free and ‏personalised digital online shopping experience. As business ‏professionals, our interactions have changed thanks to a wide ‏range of new digital tools at our disposal. Can digitisation of ‏patient pathways create similarly seamless patient interactions ‏with healthcare providers and enable novel ways of cooperation ‏between clinicians? To what extent, in the design of ‏digital tools, can we draw on the experience of other service ‏industries where digitisation is more advanced? And how much ‏of the success relies on properly tackling healthcare specific ‏challenges in user experience and technology?

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Creating a website with medical appointment bookings is ‏a typical place to start the digitisation journey. Here, seemingly ‏- adapting user experience designs from e-commerce ‏or hotel booking websites - should result in a positive patient ‏experience and in efficiency gains for healthcare providers. ‏But while this approach may be enough for standard general ‏practitioner appointments, booking more complex procedures, ‏such as MRI or CT scans on the Internet presents a whole ‏new set of challenges. For example, the required procedure ‏should preferably be correctly and precisely identified at the ‏time of booking rather than only when the patient shows up ‏at the clinic. This is important to adapt bookings to efficient ‏rostering, especially in high-volume imaging centres where ‏grouping similar procedures saves time and allows to serve ‏more patients on any given day. At the same time, it should ‏ensure, that all patients are accommodated. So, what degree of ‏precision is right: for example, in the choice of the anatomical ‏area, should we stop at “head” in a drop-down menu or distinguish ‏between “brain”, “sinuses” etc. and how can patients ‏alone choose the right specification for their MRI exam? ‏

The difficulty is that with each gain in precision, the booking ‏platform becomes more complex. This in turn leads to some ‏patients becoming confused – especially when medical terms ‏are used, giving up the web booking process altogether and ‏calling the call centre or visiting the clinic. Hence, actively ‏managing the trade-off between simplicity and precision is key ‏to good healthcare services booking web design. Such choices ‏cannot be simply outsourced to a web design consultant - ‏they need to be decided upon in a collaborative effort involving ‏digital, operational, and clinical areas. This type of collaboration ‏enables to consider the consequences of the input gathered ‏during the booking process for the entire patient journey. This ‏is similar to e-commerce – where transactional web design is ‏adapted to the order fulfilment process. 

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The standard approach to develop such websites – typical ‏in e-business, but often new to healthcare organisations – is ‏that of continuous improvement, following the launch of an ‏initial version, based on relentless drilling down detailed usage ‏data to identify and remove pain points at every digital touchpoint ‏along their journey. This approach has been proven to ‏work at Affidea: web bookings of complex MRI and CT exams ‏ can increase 2-3 fold post initial launch and reach levels of ‏several thousand a month in a single country operation. ‏

How will the process of advanced healthcare services web ‏booking evolve in the future? Looking at other industries, ‏the direction is in reducing the number of questions that the ‏customer/patient needs to answer. For example, banks and ‏insurance companies have successfully achieved this in the ‏ purchase process of say – a consumer loan, a car insurance ‏or home insurance, by drawing on information from available ‏databases.

Similarly – in healthcare, what consumers want is personalised ‏information and guidance. One might expect that in the ‏near future – key information will be read directly from a digitised ‏referral and patients’ medical records rather than input ‏by hand by the patient. E-referrals are an important step in ‏that direction.

A second natural area of digitisation is making results of ‏medical exams available remotely. Making the test results of ‏any medical examination available online is nowadays practically ‏commonplace. However, for a company like Affidea, ‏which has a significant diagnostic imaging business, delivering ‏images of CT and MRI scans to reporting radiologists, to ‏patients and to referring clinicians is also of immense value ‏for each of these groups and creates new network effects. ‏

Reporting radiologists typically access these images directly ‏in diagnostic companies’ Picture Archiving and Communication ‏Systems (PACS) and work in dedicated centres or at home ‏on medical grade monitors. Allowing radiologists’ remote work ‏enables easier demand-capacity management. It also gives ‏patients in smaller or more remote centres, access to primary or second opinion reports in sub-specialised areas: prostate ‏and breast scans with PI-RADS/ BI-RADS gradings are a ‏common example. The breadth of specialities that becomes ‏available in this way is an important part of the value proposition ‏that a focused diagnostic company brings to any single ‏hospital on top of economic considerations.

For patients and referring clinicians – the technological challenge of offering access to images is greater, since standard ‏web browsing technologies – on desktops and mobile devices ‏need to be accommodated. Images from MRI and CT scans ‏are delivered in DICOM files which measure several hundred ‏megabytes, while the size of an entire repository of a diagnostic ‏imaging business can easily approach petabytes. But, ‏if movie streaming companies can overcome the challenge, so ‏can a diagnostic imaging business, using some of the same ‏streaming technologies.

While formal reporting needs to be done by qualified radiologists ‏on medical grade monitors, easy access to diagnostic ‏images is valued by referring clinicians for illustrative ‏purposes, e.g., for discussing surgery options. Affidea is ‏deploying the access to images feature via patient portals ‏and clinician portals in more and more markets. Where this ‏feature is already in place, it has shown to facilitate discussions ‏of the more complex cases between radiologists and ‏referring clinicians as well as between referring clinicians themselves ‏in both formal and informal settings. This way – existing ‏networks are being strengthened and new networks are being ‏formed between referring clinicians and radiologists in a way ‏which benefits the patients and cements the relationship of ‏the company with the broader medical ecosystem

Disclosure of conflict of interest: Point-of-View articles are the sole opinion of the author(s) and they are part of the HealthManagement.org Corporate Engagement or Educational Community Programme.